Accommodating intraocular lenses and methods of manufacturing

ABSTRACT

An intraocular lens is disclosed that includes an optic body with a projection extending radially outwards from a peripheral surface of the optic body. The projection comprises a haptic contact surface facing radially outward, wherein the entire haptic contact surface is a flat surface. A haptic having a free distal end and a proximal portion is secured to the projection along the haptic contact surface, wherein the projection and the proximal portion interface at a butt joint without the haptic extending into the projection and without the projection extending into the haptic. The haptic also includes a haptic fluid chamber.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/760,640 filed on Mar. 16, 2018, which is a U.S. national applicationfiled under 35 U.S.C. 371 to PCT International Application No.PCT/US2016/060799 filed Nov. 7, 2016, which claims priority to U.S.Provisional Patent Application Nos. 62/252,260 filed on Nov. 6, 2015;62/321,678 filed on Apr. 12, 2016; 62/357,785 filed on Jul. 1, 2016;62/321,704 filed on Apr. 12, 2016; 62/321,666 filed on Apr. 12, 2016;62/321,665 filed on Apr. 12, 2016; 62/321,705 filed on Apr. 12, 2016;62/321,684 filed on Apr. 12, 2016; 62/321,670 filed on Apr. 12, 2016 and62/377,402 filed on Aug. 19, 2016; the contents of which areincorporated herein by reference in their entireties.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

BACKGROUND

Fluid-driven, accommodating intraocular lenses have been described. Thisdisclosure describes a wide variety of aspects of exemplary intraocularlenses that may provide benefits to some fluid-driven, accommodatingintraocular lenses. For example, it may be beneficial for a fluid-drivenintraocular lens to have an aspherical configuration after it has beenmanufactured.

SUMMARY

One aspect of the disclosure is a method of manufacturing an optic of anaccommodating intraocular lens to have an aspheric lens surface,comprising: providing an optic comprising an anterior element and aposterior element that at least partially define an optic fluid chamber,wherein at least one of the anterior element and the posterior elementhas an external surface that is spherical; and prior to inserting theaccommodating intraocular lens into an eye, changing the shape of the atleast one of the anterior element and the posterior element from thespherical configuration to an aspherical configuration.

In some embodiments changing the shape of the at least one of theanterior element and the posterior element from the sphericalconfiguration to an aspherical configuration comprises adding fluid tothe optic fluid chamber so as to increase the fluid pressure within theoptic chamber and cause the at least one of the anterior element and theposterior element to deform from the spherical configuration to theaspherical configuration. Prior to adding fluid, the method can includesecuring at least one haptic to the optic.

In some embodiments providing the optic comprises bonding the anteriorelement to the posterior element.

In some embodiments the method also includes machining at least one ofthe anterior element and the posterior element.

In some embodiments, prior to changing the shape of the at least one ofthe anterior element and the posterior element from the sphericalconfiguration to an aspherical configuration, the optic has a 10-15 Dbase state.

One aspect of the disclosure is a fluid-filled intraocular lens,comprising: an optic portion comprising an anterior element with ananterior optical surface and a posterior element with a posterioroptical surface, the anterior element and the posterior element definingan optic fluid chamber, wherein at least one of the anterior opticalsurface and the posterior optical surface has an asphericalconfiguration in an as-manufactured state, prior to insertion in an eye.

One aspect of the disclosure is an intraocular lens, comprising: anoptic portion; and a peripheral portion including a peripheral fluidchamber, the peripheral portion having a cross section, in a planepassing through an optical axis of the optic portion, in which the fluidchamber is disposed in a radially outer portion of the peripheralportion, and wherein a radially inner portion of the peripheral chamberis non-fluid.

One aspect of the disclosure is an intraocular lens, comprising: anoptic portion; and a peripheral portion including a peripheral fluidchamber, the peripheral portion, in a cross section of a plane passingthrough an optical axis of the optic portion, and in a directionorthogonal to an optical axis of the optic portion through a midpoint ofthe peripheral portion, having a radially inner fluid chamber wallthickness that is between four and twenty times the thickness of aradially outer fluid chamber wall thickness.

One aspect of the disclosure is an intraocular lens, comprising: anoptic portion; and a peripheral portion including a peripheral fluidchamber, the peripheral portion, in a cross section of a plane passingthrough an optical axis of the optic portion, has an outer surface thatis not symmetrical about every axis passing through the peripheralportion and parallel to an optical axis of the optic portion, andwherein the peripheral portion has, in a direction orthogonal to anoptical axis of the optic portion through a midpoint of the peripheralportion, having a radially inner fluid chamber wall thickness greaterthan a radially outer fluid chamber wall thickness.

One aspect of the disclosure is an intraocular lens, comprising: anoptic portion; and a peripheral portion including a peripheral fluidchamber, the peripheral portion, in a cross section of a plane passingthrough an optical axis of the optic portion, having a height dimensionmeasured in an anterior to posterior direction, wherein the greatestheight of the peripheral portion in a radially outer half of theperipheral portion is greater than the greatest height of the peripheralportion in a radially inner half of the peripheral portion.

One aspect of the disclosure is an intraocular lens, comprising: anoptic portion coupled to a peripheral portion at a coupling, thecoupling comprising a radially inner surface of the peripheral portioninterfacing a radially outer peripheral edge of the optic portion.

In some embodiments the radially inner surface of the peripheral portionhas a first end with a configuration that is different than a second endof the inner surface. The peripheral portion can include a haptic with acoupled end and a free end, the first end being closer to the hapticfree end than the coupled end. The haptic can have a configuration thatfollows a radially outer peripheral curvature of the optic from thehaptic coupled end to the free end.

In some embodiments the first end has a greater surface area than thesecond end of the radially inner surface. The first end can have atapered end configuration, wherein the taper is toward a free end of theperipheral portion.

In some embodiments the radially inner surface of the peripheral portiondefines a peripheral portion fluid port.

One aspect of the disclosure is an intraocular lens, comprising an opticbody, a projection extending radially outwards from a peripheral surfaceof the optic body, and a peripheral non-optic body having a firstportion secured to the projection.

In some embodiments a radially inner surface of the first portion of theperipheral non-optic body follows a radially peripheral surface of theprojection.

In some embodiments the projection and the first portion interface at abutt joint, with optionally flat or curved relative surfaces.

In some embodiments a radially peripheral surface of the projectioncomprises a flat surface, optionally entirely flat. A radially innersurface of the first portion of the peripheral non-optic body cancomprise a flat surface, optionally entirely flat.

In some embodiments a radially peripheral surface of the projectioncomprises a curved surface, optionally entirely curved. A radially innersurface of the first portion of the peripheral non-optic body cancomprise a curved surface, optionally entirely curved.

In some embodiments a radially peripheral surface of the projection isbetween 10 microns and 1 mm, optionally, 10 microns to 500 microns,farther away radially from a center of the optic body than theperipheral surface of the optic body.

In some embodiments the projection extends between 10 microns and 1 mm,optionally between 10 microns and 500 microns, from the peripheralsurface of the optic body.

In some embodiments the optic body and the projection are a singleintegral body.

In some embodiments the projection is attached to the optic body.

In some embodiments the optic body comprises a posterior element and ananterior element, optionally defining a fluid chamber therebetween. Theposterior element can comprise the projection. The anterior element maycomprise the projection.

In some embodiments the peripheral non-optic body further comprises afree second portion disposed away from the first portion.

In some embodiments the peripheral non-optic body comprises a peripheralfluid chamber.

In some embodiments the projection comprises at least one channel, andoptionally at least two channels, in fluid communication with aperipheral fluid chamber in the peripheral non-optic body.

In some embodiments the peripheral non-optic body has a radially innersurface, optionally with a slight curve, coupled to the projection,wherein the projection is disposed on a radially outer peripheral edgeof the optic body.

In some embodiments the peripheral non-optic body is adapted to deformin response to forces on the peripheral non-optic body due to ciliarymuscle movement to thereby move a fluid between a peripheral fluidchamber in the peripheral non-optic body and an optic fluid chamber inthe optic body to change an optical parameter of the intraocular lens.

In some embodiments the peripheral non-optic body comprises an openingconfigured to interface with the projection.

In some embodiments the projection is sized and configured to bedisposed within and interface with an opening in the peripheralnon-optic body.

One aspect of the disclosure is an intraocular lens comprising an opticbody and a peripheral non-optic body, the optic body having, in a topview, an outer edge at least a portion of which is an arc, and whereinthe peripheral non-optic body is coupled to the optic body projection ata location radially outward relative to the curve of the arc.

One aspect of the disclosure an intraocular lens wherein an adhesivebetween first and second components has a modulus of elasticity ofbetween about 0.4 and 1000 MPa, such as between about 1 MPa and 600 MPa.

One aspect of the disclosure is an intraocular lens wherein an adhesiveis 50-85% of a cross linkable polymer of a first polymeric material ofthe intraocular lens.

One aspect of the disclosure is an intraocular lens wherein an adhesivecomprises between 7.5% and 30% of a reactive acrylic monomer diluent.

One aspect of the disclosure is an intraocular lens wherein the adhesiveincludes lauryl methacrylate or similar material in an amount between2.5% and 30%.

One aspect of the disclosure is an intraocular lens, optionally,accommodating, comprising an optic portion; a peripheral portion; and atleast one ridge extending along at least a portion of the length of theperipheral portion.

One aspect of the disclosure is an intraocular lens, wherein a tip of afirst haptic overlays, optionally tapered, a second haptic, in a topview.

One aspect of the disclosure is an intraocular lens, optionallyaccommodating, including an optic portion; and a peripheral portioncoupled to the optic portion, the peripheral portion comprising a firsthaptic and a second haptic, wherein the first haptic and the secondhaptic are configured to be closely fit together to reduce gapstherebetween, optionally overlapping in a top view.

One aspect of the disclosure is an intraocular lens, optionally,accommodating, comprising an optic portion comprising an opaqueperiphery around at least a portion of the optic portion; and aperipheral non-optic portion secured to the optic portion and disposedradially outward relative to the optic portion.

One aspect of the disclosure a method of air removal during loading ofan intraocular lens, comprising: providing an intraocular lens; loadingthe intraocular lens into a cartridge; inserting a viscoelastic deliverydevice over the intraocular lens; injecting a fluid from theviscoelastic delivery device; and removing air from over a portion ofthe intraocular lens and away from the intraocular lens.

One aspect of the disclosure is a loading carrier for loading anintraocular lens and removing air over a portion of the intraocular lensin preparation for delivering the intraocular lens into an eye,comprising a base member comprising an intraocular lens receivingregion; a loading member configured to advance the intraocular lenstowards a delivery lumen; and an opening configured to allow insertionof a viscoelastic delivery device over a portion of the intraocular lensto remove air away from the intraocular lens.

One aspect of the disclosure is a method of air venting in a deliverysystem of an intraocular lens, comprising: providing a loading carrierfor a intraocular lens; loading the intraocular lens into a cartridgefrom the loading carrier, mounting a plunger assemble to the cartridge;injecting a viscoelastic fluid from the plunger assemble; and removingair out of the plunger assembly.

One aspect of the disclosure is a method of removing air from an areaadjacent an intraocular lens, comprising: providing an intraocular lenswithin a loading device in a loaded configuration; and delivering aviscoelastic material, optionally with a syringe, in the vicinity of theintraocular lens to remove air bubbles proximate the intraocular lens.

One aspect of the disclosure is an apparatus for delivering anintraocular lens into an eye, comprising: a distal tip adapted todeliver an intraocular lens into an eye; and a lumen extending from theproximal region to the distal tip, the lumen comprising a cross sectionhaving a first axis and a second axis of an internal ellipse; a firstportion configured to fold the intraocular lens without stretching theintraocular lens out, a second portion configured to form a substantialseal between an inner wall and the intraocular lens, and a third portionconfigured to compress the intraocular lens to extend the intraocularlens in length.

One aspect of the disclosure is a method for delivering an intraocularlens into an eye, comprising: engaging a delivery device to a loadingcarrier to accept the intraocular lens; folding the intraocular lenswithout stretching the intraocular lens out; forming a seal between aninner wall of the delivery device and the intraocular lens; compressingthe intraocular lens to extend the intraocular lens in length; anddelivering the intraocular lens into the eye.

One aspect of the disclosure a delivery device for delivering anintraocular lens into an eye, comprising a delivery lumen configured todeform therein an intraocular lens during delivery out of a distal port;wherein in a first cross section the inner lumen has an ellipticalshape, and in a second cross section distal to the first cross section,the inner lumen has an elliptical shape, wherein in the first crosssection the elliptical shape has a major axis and minor axis, andwherein in the second cross section the elliptical shape has a majoraxis and minor axis, wherein the major axis of the first cross sectionis perpendicular to the major axis of the second cross section.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B illustrate an exemplary accommodating intraocular lens.

FIG. 1C illustrates a sectional view of the accommodating intraocularlens from FIGS. 1A and 1B.

FIG. 1D is a top view of an exemplary posterior element of anaccommodating intraocular lens.

FIG. 1E is a sectional assembly view of an exemplary optic portion of anaccommodating intraocular lens.

FIGS. 1F and 1G illustrate an exemplary haptic.

FIG. 1H illustrate an exemplary coupling between an optic portion and ahaptic.

FIGS. 2A, 2B, and 2C illustrate an exemplary haptic.

FIGS. 2D, 2E, and 2F illustrate sectional views of the haptic from FIG.2A.

FIG. 2G illustrates an opening in a first end of the haptic from FIGS.2A-2C.

FIG. 3 illustrates exemplary diameters of an accommodating intraocularlens.

FIG. 4 illustrates an exemplary haptic.

FIGS. 5A and 5B illustrate the deformation of an exemplary haptic inresponse to exemplary forces.

FIG. 6 illustrates an exemplary fluid opening in an exemplary haptic.

FIG. 7 illustrates an exemplary fluid opening in an exemplary haptic.

FIG. 8 illustrates a sectional view of an exemplary accommodatingintraocular lens.

FIG. 9 illustrates a sectional view of an exemplary accommodatingintraocular lens with relatively short haptics.

FIG. 10 illustrate a sectional view of an exemplary accommodatingintraocular lens with an optic centered with a peripheral portion.

FIG. 11 is an exemplary haptic.

FIG. 12 shows an exemplary optic portion.

FIG. 13 shows a portion of an exemplary haptic.

FIG. 14 shows an exemplary IOL.

FIG. 15 shows an exemplary IOL.

FIG. 16 shows an exemplary IOL.

FIG. 17 shows a top view of an exemplary IOL.

FIG. 18 shows an exemplary optic portion.

FIG. 19 shows a sectional view of an exemplary IOL.

FIG. 20 shows a top view of an exemplary IOL.

FIG. 21 shows a sectional view of an exemplary IOL.

FIG. 22 shows a top view of an exemplary IOL.

FIG. 23A shows a top view of an exemplary IOL.

FIG. 23B shows a sectional view of an exemplary IOL.

FIG. 24 is a section view of a cartridge with an IOL loaded inside.

FIGS. 25A, 25B, 25C illustrate a method of air venting during thedelivery process.

FIGS. 26A, 26B, and 26C show viscoelastic fluid traveling from a syringethrough a support tube.

FIG. 27 is a top view of an exemplary cartridge, which can be used todeliver an intraocular lens into an eye.

FIGS. 28A, 28B, 28C, and 28D illustrate exemplary internal crosssections of the cartridge in FIG. 27.

DETAILED DESCRIPTION

The disclosure relates generally to accommodating intraocular lenses. Insome embodiments the accommodating intraocular lenses described hereinare adapted to be positioned within a native capsular bag in which anative lens has been removed. In these embodiments a peripheralnon-optic portion (i.e., a portion not specifically adapted to focuslight on the retina) is adapted to respond to capsular bag reshaping dueto ciliary muscle relaxation and contraction. The response is adeformation of the peripheral portion that causes a fluid to be movedbetween the peripheral portion and an optic portion to change an opticalparameter (e.g., power) of the intraocular lens.

FIG. 1A is a top view illustrating accommodating intraocular lens 10that includes optic portion 12 and a peripheral portion that in thisembodiment includes first and second haptics 14 coupled to and extendingperipherally from optic portion 12. Optic portion 12 is adapted torefract light that enters the eye onto the retina. Haptics 14 areconfigured to engage a capsular bag and are adapted to deform inresponse to ciliary muscle related capsular bag reshaping. FIG. 1B is aperspective view of intraocular lens 10 showing optic portion 12 andhaptics 14 coupled to optic portion 12.

The haptics are in fluid communication with the optic portion. Eachhaptic has a fluid chamber that is in fluid communication with an opticchamber in the optic portion. The haptics are formed of a deformablematerial and are adapted to engage the capsular bag and deform inresponse to ciliary muscle related capsular bag reshaping. When thehaptics deform the volume of the haptic fluid chamber changes, causing afluid disposed in the haptic fluid chambers and the optic fluid chamberto either move into the optic fluid chamber from the haptic fluidchambers, or into the haptic fluid chambers from the optic fluidchamber. When the volume of the haptic fluid chambers decreases, thefluid is moved into the optic fluid chamber. When the volume of thehaptic fluid chamber increases, fluid is moved into the haptic fluidchambers from the optic fluid chamber. The fluid flow into and out ofthe optic fluid chamber changes the configuration of the optic portionand the power of the intraocular lens.

FIG. 1C is a side sectional view through Section A-A indicated in FIG.1A. Optic portion 12 includes deformable anterior element 18 secured todeformable posterior element 20. Each haptic 14 includes a fluid chamber22 that is in fluid communication with optic fluid chamber 24 in opticportion 12. Only the coupling between the haptic 14 to the left in thefigure and option portion 12 is shown (although obscured) in thesectional view of FIG. 1C. The haptic fluid chamber 22 to the left inthe figure is shown in fluid communication with optic fluid chamber 24via two apertures 26, which are formed in posterior element 20. Thehaptic 14 to the right in FIG. 1C is in fluid communication with opticchamber 24 via two additional apertures also formed in posterior element(not shown) substantially 180 degrees from the apertures shown.

FIG. 1D is a top view of posterior element 20 (anterior element 18 andhaptics 14 not shown). Posterior element 20 includes buttress portions29 in which channels 32 are formed. Channels 32 provide fluidcommunication between optic portion 12 and haptics 14. Apertures 26 aredisposed at one end of channels 32. The optic fluid chamber 24 istherefore in fluid communication with a single haptic via two fluidchannels. Buttress portions 29 are configured and sized to be disposedwithin an opening formed in haptics 14 that defines one end of thehaptic fluid chamber, as described below. Each of buttress portions 29includes two channels formed therein. A first channel in a firstbuttress is in alignment with a first channel in the second buttress.The second channel in the first buttress is in alignment with the secondchannel in the second buttress.

There are exemplary advantages to having two channels in each buttressas opposed to one channel. A design with two channels rather than onechannel helps maintain dimensional stability during assembly, which canbe important when assembling flexible and thin components. Additionally,it was observed through experimentation that some one-channel designsmay not provide adequate optical quality throughout the range ofaccommodation. In particular, lens astigmatism may occur in someone-channel designs, particularly as the intraocular lens accommodated.It was discovered that the two-channel buttress designs described hereincan help reduced astigmatism or the likelihood of astigmatism,particularly as the lens accommodated. Astigmatism is reduced in theseembodiments because the stiffness of the buttress is increased by therib portion between the two channels. The additional stiffness resultsin less deflection due to pressure changes in the channels. Lessdeflection due to the pressure changes in the channels results in lessastigmatism. In some embodiments the channels are between about 0.4 mmand about 0.6 mm in diameter. In some embodiments the channels are about0.5 mm in diameter. In some embodiments the distance between theapertures is about 0.1 mm to about 1.0 mm.

FIG. 1E is a side assembly view through section A-A of optic portion 12,which includes anterior element 18 and posterior element 20 (haptics notshown for clarity). By including fluid channels 32 in posterior element20, posterior element 20 needs to have enough structure through whichthe channels 32 can be formed. Buttress portions 29 provide thatstructures in which channels 32 can be formed. At its peripheral-mostportion posterior element 20 is taller than anterior element 18 in theanterior-to-posterior direction. In alternative embodiments, thechannels can be formed in anterior element 18 rather than posteriorelement 20. The anterior element would include buttress portions 29 orother similar structure to provide structure in which the channels canbe formed. In these alternative embodiments the posterior element couldbe formed similarly to anterior element 18.

As shown in FIG. 1E, posterior element 20 is secured to anterior element18 at peripheral surface 28, which extends around the periphery ofposterior element 20 and is a flat surface. Elements 18 and 20 can besecured together using known biocompatible adhesives. Anterior element18 and posterior element 20 can also be formed from one material toeliminate the need to secure two elements together. In some embodimentsthe diameter of the region at which anterior element 18 and posteriorelement 20 are secured to one another is about 5.4 mm to about 6 mm indiameter.

In some embodiments the thickness of anterior element 18 (measured inthe anterior-to-posterior direction) is greater along the optical axis(“OA” in FIG. 1C) than at the periphery. In some embodiments thethickness increases continuously from the periphery towards the thickestportion along the optical axis.

In some embodiments the thickness of posterior element 20 decreases fromthe location along the optical axis towards the edge of central region“CR” identified in FIG. 1C. The thickness increases again radiallyoutward of central region CR towards the periphery, as can be seen inFIG. 1C. In some particular embodiments central region CR is about 3.75mm in diameter. The apertures are formed in beveled surface 30.

In some embodiments the thickness of posterior element 20 along theoptical axis is between about 0.45 mm and about 0.55 mm and thethickness at the periphery of posterior element 20 is between about 1.0mm and about 1.3.

In some embodiments the thickness of posterior element 20 along theoptical axis is about 0.5 mm and the thickness at the periphery ofposterior element 20 is about 1.14 mm.

In some embodiments the thickness of anterior element 18 along theoptical axis is between about 0.45 mm to about 0.55 mm, and in someembodiments is between about 0.50 mm to about 0.52 mm. In someembodiments the thickness at the periphery of anterior element 18 isbetween about 0.15 mm and about 0.4 mm, and in some embodiments isbetween about 0.19 mm and about 0.38 mm.

In one particular embodiment the thickness of anterior element 18 alongthe optical axis is about 0.52 mm and the thickness of the periphery ofanterior element 18 is about 0.38 mm, and the thickness of posteriorelement 20 along the optical axis is about 0.5 mm and the thickness atthe periphery of posterior element 20 is about 1.14 mm.

In one particular embodiment the thickness of anterior element 18 alongthe optical axis is about 0.5 mm and the thickness of the periphery ofanterior element 18 is about 0.3 mm, and the thickness of posteriorelement 20 along the optical axis is about 0.5 mm and the thickness atthe periphery of posterior element 20 is about 1.14 mm.

In one particular embodiment the thickness of anterior element 18 alongthe optical axis is about 0.51 mm and the thickness of the periphery ofanterior element 18 is about 0.24 mm, and the thickness of posteriorelement 20 along the optical axis is about 0.5 mm and the thickness atthe periphery of posterior element 20 is about 1.14 mm.

In one particular embodiment the thickness of anterior element 18 alongthe optical axis is about 0.52 mm and the thickness of the periphery ofanterior element 18 is about 0.19 mm, and the thickness of posteriorelement 20 along the optical axis is about 0.5 mm and the thickness atthe periphery of posterior element 20 is about 1.14 mm.

The optic portion is adapted to maintain optical quality throughoutaccommodation. This ensures that as the accommodating intraocular lenstransitions between the dis-accommodated and accommodatedconfigurations, the optic portion maintains optical quality. A number offactors contribute to this beneficial feature of the accommodatingintraocular lenses herein. These factors include the peripheral regionat which anterior element 18 is secured to posterior element 20, theshape profile of the anterior element 18 and posterior element 20 insidecentral region CR of the optic portion (see FIG. 1C), and the thicknessprofiles of anterior element 18 and posterior element 20. Thesecontributing factors ensure that both the anterior and posteriorelements flex in such a way as to maintain the shape necessary tomaintain optical quality across a range of optical powers.

FIG. 1F illustrates one haptic 14 from intraocular lens 10 (opticportion 12 and the second haptic not shown for clarity). Haptic 14includes radially outer portion 13 adapted to face the direction of thezonules, and radially inner portion 11, which faces the periphery of theoptic (not shown). Haptic 14 includes a first end region 17 which issecured to optic portion 12, and second end region 19 that is closed.Haptic 14 also includes opening 15 in first end region 17 that providesthe fluid communication with the haptic. In this embodiment opening 15is sized and configured to receive buttress portion 29 of optic portion12 therein.

FIG. 1G is a close up view of opening 15 in haptic 14, which is adaptedto receive buttress portion 29 therein. The opening 15 has curvedsurfaces 33 and 35 that are shaped to mate with curved surfaces on theoptic buttress 29. Surface 31 surrounds opening 15 and provides asurface to which a corresponding surface of the optic can be secured.

FIG. 1H is a top close up view of buttress portion 29 (in phantom) fromposterior element 20 disposed within opening 15 in haptic 14 (anteriorelement of the optic not shown for clarity). Channels 32 are shown inphantom. Haptic 14 includes fluid chamber 22 defined by inner surface21. Fluid moves between the optic fluid chamber and haptic fluid chamber22 through channels 32 upon the deformation of haptic 14.

FIG. 2A is a top view showing one haptic 14 shown in FIGS. 1A-1H. Theoptic portion and the second haptic are not shown. Four sections A-D areidentified through the haptic. FIG. 2B illustrates a side view of haptic14, showing opening 15 and closed end 19. FIG. 2C is a side view ofhaptic 14 showing radially outer portion 13 and closed end 19.

FIG. 2D is the cross sectional view through section A-A shown in FIG.2A. Of the four sections shown in FIG. 2A, section A-A is the sectionclosest to closed end 19. Radially inner portion 11 and radially outerportion 13 are identified. Fluid channel 22 defined by surface 21 isalso shown. In this section the radially inner portion 40 is radiallythicker (in the direction “T”) than radially outer portion 42. Innerportion 40 provides the haptic's stiffness in the anterior-to-posteriordirection that more predictably reshapes the capsule in theanterior-to-posterior direction. Radially inner portion 40 has agreatest thickness dimension 41, which is along an axis of symmetry inthis cross section. The outer surface of haptic 14 has a generallyelliptical configuration in which the greatest height dimension, in theanterior-to-posterior direction (“A-P”), is greater than the greatestthickness dimension (measured in the “T” dimension). The fluid chamber22 has a general D-shaped configuration, in which the radially innerwall 43 is less curved (but not perfectly linear) than radial outer wall45. Radially outer portion 42 engages the capsular bag where the zonulesattach thereto, whereas the thicker radially portion 40 is disposedadjacent the optic.

FIG. 2E illustrates section B-B shown in FIG. 2A. Section B-B issubstantially the same as section A-A, and FIG. 2E provides exemplarydimensions for both sections. Radially inner portion 40 has a greatestthickness along the midline of about 0.75 mm (in the radial direction“T”). Radially outer portion 42 has a thickness along the midline ofabout 0.24 mm. Fluid chamber 22 has a thickness of about 0.88 mm. Haptic14 has a thickness along the midline of about 1.87 mm. The height of thehaptic in the anterior to posterior dimension is about 2.97 mm. Theheight of the fluid chamber is about 2.60 mm. In this embodiment thethickness of the radially inner portion 40 is about 3 times thethickness of the radially outer portion 42. In some embodiments thethickness of the radially inner portion 40 is about 2 times thethickness of the radially outer portion 42. In some embodiments thethickness of the radially inner portion 40 is about 2 to about 3 timesthe thickness of the radially outer portion 42. In some embodiments thethickness of the radially inner portion 40 is about 1 to about 2 timesthe thickness of the radially outer portion 42.

Fluid chamber 22 is disposed in the radially outer portion of haptic 14.Substantially the entire radially inner region of haptic 14 in thissection is bulk material. Since the fluid chamber 22 is defined bysurfaces 43 and 45 (see FIG. 2D), the positioning and size of fluidchamber 22 depends on the thickness of the radially inner portion 40 andthe radially outer portion 42.

FIG. 2F illustrates Section C-C shown in FIG. 1A. In Section C-Cradially inner portion 40 is not as thick as radially inner portion 40in sections A-A and B-B, although in Section C-C radially inner portion40 is slightly thicker than radially outer portion 42. In thisparticular embodiment radially inner portion 40 is about 0.32 mm inSection C-C. Radially outer portion 42 has a thickness about the same asthe radially outer thickness in Sections A-A and B-B, about 0.24 mm. Theouter surface of haptic 14 does not have the same configuration as theouter surface in Sections A-A and Section B-B. In Section C-C theradially inner outer surface of haptic 51 is more linear than inSections A-A and Section B-B, giving the outer surface of haptic inSection C-C a general D-shape. In Section C-C fluid chamber 22 has ageneral D-shape, as in Sections A-A and Section B-B. The haptic, inSection C-C has a fluid chamber configuration that is substantially thesame as the fluid chamber configurations in Sections A-A and B-B, buthas an outer surface with a configuration different than theconfiguration of the outer surface of haptic 14 in Sections A-A and B-B.

The thinner radially inner portion 40 in Section C-C also creates accesspathways 23 that are shown in FIG. 1A. This space between optic portion12 and haptics 14 allows a physician to insert one or more irrigationand/or aspiration devices into space 23 during the procedure and applysuction to remove viscoelastic fluid that may be used in the delivery ofthe intraocular lens into the eye. The pathways 23 could also beanywhere along the length of the haptic, and there could be more thanone pathway 23. This application incorporates by reference thedisclosure in FIGS. 23 and 24, and the textual description thereof, fromU.S. Pub. No. 2008/0306588, which include a plurality of pathways in thehaptics.

FIG. 2G shows a view through Section D-D from FIG. 2A. Haptic 14includes opening 15 therein, which is adapted to receive the buttressfrom the optic portion as described herein. The height of opening 15 inthis embodiment is about 0.92 mm. The width, or thickness, of theopening is about 2.12 mm.

FIG. 3 illustrates relative diameters of optic portion 12 (not shown)and of the peripheral portion, which includes two haptics 14 (only onehaptic is shown). In this embodiment the optic has a diameter of about6.1 cm, while the entire accommodating intraocular lens, including theperipheral portion, has a diameter of about 9.95 cm. The dimensionsprovided are not intended to be strictly limiting.

FIG. 4 is a top view of haptic 14, showing that haptic 14 subtends anangle of about 175 degrees around optic (i.e., substantially 180degrees). The optic portion is not shown for clarity. The two hapticstherefore each subtend an angle of about 180 degrees around the optic. Afirst region 61 of haptic 14 is shown to subtend exemplary angle ofabout 118 degrees. This is the radially outermost portion of haptic 14,is adapted to engage the capsular bag, and is adapted to be mostresponsive to capsular shape changes. Region 61 can be thought of as themost responsive part of haptic 14.

The angle between Sections A-A and B-B, which are considered theboundaries of the stiffer radially inner portion of the haptic, is about40 degrees. The stiff radially inner portion of haptic 14 is positioneddirectly adjacent the periphery of the optic. The dimensions and anglesprovided are not intended to be strictly limiting.

FIGS. 5A and 5B illustrate a portion of accommodating intraocular lens10 positioned in a capsular bag (“CB”) after a native lens has beenremoved from the CB. The anterior direction is on top and the posteriordirection is on bottom in each figure. FIG. 5A shows the accommodatingintraocular lens in a lower power, or dis-accommodated, configurationrelative to the high power, or accommodated, configuration shown in FIG.5B.

The elastic capsular bag “CB” is connected to zonules “Z,” which areconnected to ciliary muscles “CM.” When the ciliary muscles relax, asshown in FIG. 5A, the zonules are stretched. This stretching pulls thecapsular bag in the generally radially outward direction due to radiallyoutward forces “R” due to the general equatorial connection locationbetween the capsular bag and the zonules. The zonular stretching causesa general elongation and thinning of the capsular bag. When the nativelens is still present in the capsular bag, the native lens becomesflatter (in the anterior-to-posterior direction) and taller in theradial direction, which gives the lens less power. Relaxation of theciliary muscle, as shown in FIG. 5A, provides for distance vision. Whenthe ciliary muscles contract, however, as occurs when the eye isattempting to focus on near objects, the radially inner portion of themuscles move radially inward, causing the zonules to slacken. This isillustrated in FIG. 5B. The slack in the zonules allows the capsular bagto move towards a generally more curved configuration in which theanterior surface has greater curvature than in the dis accommodatedconfiguration, providing higher power and allowing the eye to focus onnear objects. This is generally referred to as “accommodation,” and thelens is said to be in an “accommodated” configuration.

In section A-A (which is the same as section B-B) of haptic 14,illustrated in FIGS. 5A and 5B, radially inner portion 40 includesthicker bulk material that provides haptic 14 with stiffness in theanterior-to-posterior direction. When capsular bag forces are applied tothe haptic in the anterior-to-posterior direction, the inner portion 40,due to its stiffness, deforms in a more repeatable and predictablemanner making the base state of the lens more predictable. Additionally,the haptic, due to its stiffer inner portion, deforms the capsule in arepeatable way in the anterior-to-posterior direction. Additionally,because the haptic is less flexible along the length of the haptic, theaccommodating intraocular lens's base state is more predictable becausebending along the length of the haptic is one way in which fluid can bemoved into the optic (and thereby changing the power of the lens).Additional advantages realized with the stiffer inner portion are thatthe haptics are stiffer to other forces such as torqueing and splayingbecause of the extra bulk in the inner portion.

The radially outer portion 42 is the portion of the haptic that directlyengages the portion of the capsular bag that is connected to thezonules. Outer portion 42 of the haptics is adapted to respond tocapsular reshaping forces “R” that are applied generally radially whenthe zonules relax and stretch. This allows the haptic to deform inresponse to ciliary muscle related forces (i.e., capsular contractionand relaxation) so that fluid will flow between the haptic and the opticin response to ciliary muscle relaxation and contraction. This isillustrated in FIG. 5B. When the ciliary muscles contract (FIG. 5B), theperipheral region of the elastic capsular bag reshapes and appliesradially inward forces “R” on radially outer portion 42 of haptic 14.The radially outer portion 42 is adapted to deform in response to thiscapsular reshaping. The deformation decreases the volume of fluidchannel 22, which forces fluid from haptic chamber 22 into optic chamber24. This increases the fluid pressure in optic chamber 42. The increasein fluid pressure causes flexible anterior element 18 and flexibleposterior element 20 to deform, increasing in curvature, and thusincreasing the power of the intraocular lens.

The haptic is adapted to be stiffer in the anterior-to-posteriordirection than in the radial direction. In this embodiment the radiallyouter portion 42 of haptic 14 is more flexible (i.e., less stiff) in theradial direction than the stiffer inner portion 40 is in theanterior-to-posterior direction. This is due to the relative thicknessesof outer portion 42 and inner portion 40. The haptic is thus adapted todeform less in response to forces in the anterior-to-posterior directionthan to forces in the radial direction. This also causes less fluid tobe moved from the haptic into the optic in response to forces in theanterior-to-posterior direction than is moved into the optic in responseto forces in the radial direction. The haptic will also deform in a morepredictable and repeatable manner due to its stiffer radially innerportion.

The peripheral portion is thus more sensitive to capsular bag reshapingin the radial direction than to capsular bag reshaping in theanterior-to-posterior direction. The haptics are adapted to deform to agreater extent radially than they are in the anterior-to-posteriordirection. The disclosure herein therefore includes a peripheral portionthat is less sensitive to capsular forces along a first axis, but ismore sensitive to forces along a second axis. In the example above, theperipheral portion is less sensitive along the posterior-to-anterioraxis, and is more sensitive in the radial axis.

An exemplary benefit of the peripheral portions described above is thatthey deform the capsular bag in a repeatable way and yet maintain a highdegree of sensitivity to radial forces during accommodation. Theperipheral portions described above are stiffer in theanterior-to-posterior direction than in the radial direction.

An additional example of capsular forces in the anterior-to-posteriordirection is capsular forces on the peripheral portion after theaccommodating intraocular lens is positioned in the capsular bag, andafter the capsular bag generally undergoes a healing response. Thehealing response generally causes contraction forces on the haptic inthe anterior-to-posterior direction, identified in FIG. 5A by forces“A.” These and other post-implant, such as non-accommodating-related,capsular bag reshaping forces are described in U.S. application Ser. No.12/685,531, filed Jan. 11, 2010, which is incorporated herein byreference. For example, there is some patient to patient variation incapsular bag size, as is also described in detail in U.S. applicationSer. No. 12/685,531, filed Jan. 11, 2010. When an intraocular lens ispositioned within a capsular bag, size differences between the capsuleand intraocular lens may cause forces to be exerted on one or moreportions of the intraocular lens in the anterior-to-posterior direction.

In the example of capsular healing forces in the anterior-to-posteriordirection, the forces may be able to deform a deformable haptic beforeany accommodation occurs. This deformation changes the volume of thehaptic fluid chamber, causing fluid to flow between the optic fluidchamber and the haptic fluid chambers. This can, in some instancesundesirably, shift the base power of the lens. For example, fluid can beforced into the optic upon capsular healing, increasing the power of theaccommodating intraocular lens, and creating a permanent myopic shiftfor the accommodating intraocular lens. Fluid could also be forced outof the optic and into the haptics, decreasing the power of theaccommodating intraocular lens.

As used herein, “radial” need not be limited to exactly orthogonal tothe anterior-to-posterior plane, but includes planes that are 45 degreesfrom the anterior-to-posterior plane.

Exemplary fluids are described in U.S. application Ser. No. 12/685,531,filed Jan. 11, 2010, and in U.S. application Ser. No. 13/033,474, filedFeb. 23, 2011, both of which are incorporated herein by reference. Forexample, the fluid can be a silicone oil that is or is not index-matchedwith the polymeric materials of the anterior and posterior elements.When using a fluid that is index matched with the bulk material of theoptic portion, the entire optic portion acts a single lens whose outercurvature changes with increases and decreases in fluid pressure in theoptic portion.

In the embodiment in FIGS. 2A-2G above the haptic is a deformablepolymeric material that has a substantially uniform composition inSections A-A, B-B, and C-C. The stiffer radially inner body portion 40is attributed to its thickness. In alternative embodiments the radiallyinner body portion has a different composition that the outer bodyportion, wherein the radially inner body portion material is stifferthan the material of the radially outer body portion. In thesealternative embodiments the thicknesses of the radially inner and outerportions can be the same.

FIG. 6 illustrates haptic 50, which is the same haptic configuration asin shown in FIG. 2B. The radially outer portion 54 is identified. Thehaptic has axis “A” halfway through the height of the haptic, oralternatively stated, axis A passes through the midpoint of the heightof the haptic in the anterior-to-posterior direction. Opening 52, inwhich the optic buttress is disposed, is on the posterior side of axisA. In this embodiment the optic sits slightly closer to theposterior-most portion of the haptics than the anterior-most portion ofthe haptics. That is, in this embodiment the optic is not centered withthe haptics in the anterior-to-posterior direction.

FIG. 7 illustrates an alternative haptic 60 (optic not shown), whereinthe radially outer portion 64 is identified. Haptic 60 includes axis “A”halfway through the thickness of the haptic, or alternatively stated,axis A passes through the midpoint of the height of the haptic in theanterior-to-posterior direction. Opening 62 is symmetrical about theaxis A, and an axis passing through the midpoint of opening 62 isaligned with axis A. Additionally, axis A is an axis of symmetry forhaptic 60. The symmetry of the haptic along axis A can improve theability to mold low relatively low stress components. FIG. 8 shows anembodiment of intraocular lens 70 in which the optic 72 is coupled totwo haptics 60, which are the haptics shown in FIG. 7. The optic sitsfurther in the anterior direction that in the embodiment in which theopening is not along the midline of the haptic. In this embodiment,optic 72 is centered, in the anterior-to-posterior direction, with thehaptics. The cross sections A-A, B-B, and C-C of haptic 60 are the sameas those shown in other embodiments shown above, but the haptics canhave any alternative configuration as well.

FIG. 9 illustrates intraocular lens 80 including optic 82 and twohaptics 84. The optic is the same as the optic portions describedherein. Haptics 84 are not as tall, measured in theanterior-to-posterior direction, as haptic 60, haptic 50, or haptic 14.In exemplary embodiments haptics 84 are between about 2.0 mm and about3.5 mm tall, and in some embodiments they are about 2.8 mm tall.Intraocular lens 80 can be considered a size “small” accommodatingintraocular lens for patients with a capsular bag that is below acertain threshold size. The posterior surface of posterior element 86 isdisposed slightly further in the posterior direction than theposterior-most portions 90 of haptics 84.

FIG. 10 illustrates an accommodating intraocular lens 98 that includesan optic body 100 and a peripheral non-optic body, which in thisembodiment includes haptics 160 and 180. Optic body 100 can be in fluidcommunication with one or both haptics 160 and 180, and fluid movementbetween the optic and haptics in response to ciliary muscle movement canchange the power of the intraocular lens. This general process offluid-driven accommodation in response to deformation of the haptics canbe found herein. Optic 100 includes anterior element 120 secured toposterior element 140, together defining an optic fluid chamber incommunication with haptic fluid chambers 170 and 190 in the haptics. The“height” of the components in this disclosure is measured in theanterior-to-posterior direction. Optic 100 has a greatest height “H1”dimension measured in the anterior to posterior direction along theoptic axis. Haptics 160 and 180 have greatest height “H2” dimensionsmeasured in the anterior to posterior direction parallel to the opticalaxis. The optic body has a centerline B, measured perpendicular to theoptical axis and passing through the midpoint of H1. The haptics alsohave centerlines, B, measured perpendicular to the optical axis andpassing through the midpoint of H2. In this embodiment the centerlinescoincide and are the same centerline B. Stated alternatively, theanterior-most surface or point of anterior element 120 is spaced fromthe anterior-most point or surface of the haptics the same distance asis the posterior-most surface or point of posterior element 140 from theposterior-most point or surface of the haptics. They can be consideredsubstantially the same lines in some embodiments even if they do notcoincide, but are near in space to one another (e.g., a few millimetersaway). An optic centered with the haptics is also shown in FIG. 8.

In this embodiment the position of the optic 100 relative to the hapticscan provide some benefits. For example, during folding and/or insertion,the centered (or substantially centered) optic, measured in theanterior-to-posterior direction, can prevent or reduce the likelihood ofone or more haptics from folding over the anterior element 120 orposterior element 140, which may happen when the optic body is notsubstantially centered relative to the haptics. For example, an opticthat is much closer to the posterior side of the lens may increase thelikelihood that a haptic (e.g., a haptic free end) can fold over theanterior surface of the optic during deformation, loading, orimplantation.

An additional benefit to having the optic body 100 centered orsubstantially centered relative to the peripheral body is that is iteasier for the optic to pass through the capsulorhexis when placed inthe eye. When the optic is closer to the posterior side of the lens, itmay be more difficult for it to rotate into the capsular bag.

An additional benefit is that, compared to optics that are further inthe posterior direction, glare from the intraocular lens is reduced. Bymoving the optic in the anterior direction (it will be closer to theiris once implanted), less light can reflect off of the radially outerperipheral edge of the optic (i.e., the edge surface adjacent thehaptics), thus reducing glare from edge effect.

In some embodiments of the intraocular lens in FIG. 10, anterior element120 can have a height between 0.2 mm and 0.35 mm, such as between 0.25mm and 0.30 mm, such as about 0.28 mm, and the posterior element 140 canhave a height between 0.36 mm and 0.50 mm, such as between 0.40 mm and0.45 mm, such as about 0.43 mm.

Prior to insertion, such as during manufacturing, the intraocular lensshown in FIG. 10 can be filled with fluid. In some embodiments theintraocular lens has a base state (at zero fluid pressure in the optic;or no fluid inside it) less than 15 D, such as about 13 D. About 13 D,as used herein, refers to base states about 10 D to about 15 D. Byhaving a base state of about 13 D, it may be possible to generally onlyhave to change the fluid pressure in one direction—higher. When the basestate of an intraocular lens is higher, such as about 20 D, it may benecessary to change the fluid pressure either higher or lower, dependingon the desired vision correction and the intended use of the intraocularlens. By having a lower base state, the changes to the state of the lensbecome more predictable by only having to change the base state in onedirection.

One aspect of this disclosure is an accommodating intraocular lens,optionally fluid-filled and fluid-driven, that has an aspheric opticalsurface after manufacture and prior to implantation. That is, theintraocular lens is manufactured with an aspheric optical surface. Anaspheric optical surface can avoid spherical aberration when the pupilis fully dilated. There can be challenges in manufacturing anintraocular lens, particularly an accommodating, fluid-drivenintraocular lens, with aspheric optical surfaces.

In some embodiments the accommodating intraocular lens is manufacturedwith an aspheric anterior surface and/or an aspheric posterior surface.One exemplary manner in which a fluid-filled accommodating intraocularlens can have an anterior or posterior optical surface with built-inasphericity is to, during manufacturing, create the optical surface witha spherical configuration prior to fluid filling, then create theasphericity in the optical surface during the fill process. For example,during manufacture, one or both of the anterior surface and theposterior surface can be manufactured to have spherical outer opticalsurfaces. The anterior surface can then be secured to the posteriorsurface. One or more haptics can then be secured to the optic. In someembodiments the optic is manufactured, but prior to filling, to have abase state (at zero fluid pressure in the optic; or no fluid inside it)less than 15 D, such as about 13 D. About 13 D, as used herein, refersto base states about 10 D to about 15 D. When a fluid is injected intothe accommodating intraocular lens (e.g., via a septum), the fluidfilling step can increase the fluid pressure in the optic and cause theanterior surface and/or the posterior surface of the optic to have anaspherical configuration. One aspect of this disclosure is thus a methodof manufacturing an accommodating intraocular lens that includescreating an optic with a fluid-filled state prior to insertion, whichhas asphericity built into one or more optical surfaces, such as ananterior optic surface. The method of manufacturing can includemanufacturing the optic wherein the optical surface is spherical priorto fluid filling.

It may be desirable to maintain good optical quality in at least onesurface of the central portion of the optic as it is deformed, eitherthroughout disaccommodation or throughout accommodation. One of theaspects of the disclosure is an optic that has a very controlled andsomewhat stable amount of asphericity in a central region of the optic,across the whole range of powers. This may be referred to herein as“beneficial asphericity” in a central region of the optic. Thebeneficial asphericity includes lens surfaces with surface aberrationsthat are configured to compensate for the spherical aberrations in theoptical system of the eye, and contribute to maintaining opticalquality. The beneficial asphericity is maintained across all orsubstantially all of the range of powers during accommodation anddisaccommodation. In some instances the asphericity can be controlledsuch that the spherical aberration of the whole lens systems can remainlow (or zero) across all range of power. The optic region outside of thecentral region may have larger, more uncontrolled amount of asphericity.

In some embodiments the central region of the optic, or the region ofbeneficial asphericity, has a diameter of less than 6.5 mm, less than6.0 mm, less than 5.5 mm, less than 5.0 mm, less than 4.5 mm, less than4.0 mm, less than 3.5 mm, or even less than 3.0 mm. In some embodimentsthe central region has a diameter between 3.5 mm and 5.5 mm. In someembodiments the central region of the optic with beneficial asphericityhas a diameter less than 90% of the diameter of the optic body, lessthan 85%, less than 80%, or less than 75%. The diameter of the optic canbe between 4 mm and 8 mm, such as between 5 mm and 7 mm. In someembodiments the central region is between 4 mm and 5 mm, and the opticdiameter is between 5 mm and 7 mm. In some embodiments the centralregion is between 4.25 mm and 4.75 mm, and the optic diameter is between5.75 mm and 6.25 mm.

The configuration of the anterior element and the posterior element caninfluence the configurations that they assume throughout deformation,either throughout accommodation or disaccommodation. In someembodiments, one or both of the anterior element and the posteriorelement is contoured, or configured, such that the central region of theoptic has the beneficial asphericity that is controlled and beneficialto the overall system of the eye. In this embodiment anterior element120, and to a lesser extent posterior element 140, are configured sothat an anterior surface of anterior element 120 and a posterior surfaceof posterior element 140 maintain the controlled, beneficial asphericityin a central region of the optic during accommodation. In thisembodiment one aspect of the configuration that contributes to thecentral portion maintaining beneficial asphericity is that anteriorelement 120, and optionally the posterior element 140, has a thickness(also referred to as “height” herein) that is greater in the center(such as at the apex of the anterior element 120) than at the peripheryof the anterior element 120. An additional aspect of the configurationthat contributes to beneficial asphericity is that the anterior elementis flatter on the inner surface (posterior surface) than on the outersurface (anterior surface). During accommodation, the central region ofthe anterior element 120 steepens in the center (which increases powerof the AIOL), but the optic body maintains its beneficial asphericity,due at least in part to the relatively larger thickness of the anteriorelement central region. It may also be aspherical prior to accommodatingin the exemplary embodiments in which asphericity is built into theanterior element, described below.

The thickness contours of the anterior and posterior elements cancontribute to the optic maintaining the beneficial asphericity acrossall powers, an example of which is the thickness of the anterior andposterior elements.

FIG. 11 illustrates an exemplary haptic that can be part of any of theaccommodating intraocular lenses herein or other suitable IOLs notdescribed herein. One or both haptics can be configured as shown in FIG.11. The haptic in FIG. 11 is labeled as “160,” but it is understood thatthe haptic in FIG. 11 can be a part of intraocular lenses other thanthat shown in FIG. 10. The haptic includes a surface 220 that is securedto an outer edge of the optic body. Surface 220 is a radially innersurface of the haptic, and is configured with a slight curve to it(along the length of the haptic) that is substantially the same curve asthe outer edge of the optic so that the entire surface 220 interfacesthe optic body outer edge surface(s). Surface 220 has a configurationrelative to the optic such that an extension of the surface does notpass through an optic axis of the optic. An adhesive can be used tosecure surface 220 to the optic outer edge surface(s). In thisembodiment the coupling between the haptic and the optic body does notinclude one of the haptic and optic being disposed within a channel,bore, or aperture in the other, as can be used for some haptic/opticcoupling designs, such as in the embodiment shown in FIGS. 1A-9. Someexemplary advantages of this type of design are described below.

FIG. 12 shows a perspective view of optic 100, with the haptics excludedfor clarity. Surface 220 of the haptic (not shown) is secured to bothanterior element 120 and posterior element 140 of the optic body 100.Most of surface 220 interfaces posterior portion 140, but a portion ofsurface 220 interfaces anterior element 120. This is because the outeredge of the optic body is largely comprised of the posterior element140. With different optic configurations, surface 220 could be securedto more of the anterior element than the posterior element. It is alsonoted that the height H3 of surface 220 (see FIG. 11) is substantiallythe same as the height of the outer edge of the optic body.

Haptic 160 surface 220 has a first end region 230 (see FIG. 11) that hasa configuration with a larger surface than second end region 250. Endregion 230 of surface 220 has a larger surface area than end region 250of surface 220, and includes at least partially beveled surfaces B, asshown in FIG. 13. The width W1 of end region 230 is greater than widthW2 of end region 250. The configuration of end region 230 can provideexemplary benefits. For example, as part of a process of loading theintraocular lens into a delivery device and/or into an eye of a patient,one or both of haptics 160 and 180 may be “splayed” relative to optic.That is, one or both haptics can be reconfigured from the natural atrest configuration shown in FIGS. 10-14 by moving free end 170 of hapticaway from the optic body. The extent to which the free end (and a largeportion of the haptic) is moved away from the optic during splaying canvary. In some methods of loading, one of both haptics can be splayedsubstantially, such that the haptic is oriented behind or in front ofthe optic. In some instances the haptic free end (i.e., the end of thehaptic not coupled directly to the optic) is “pointing” substantially180 degrees from where it is pointing in the at-rest configuration. Ingeneral, splaying the haptic(s) causes stresses at the couplinginterface between the haptic and optic. The coupling interface betweenthe optic and haptic must be able to withstand these forces so that thehaptic does not disengage from the optic. When splaying haptics, therecan be a high stress location at the optic/haptic coupling at the end ofthe interface 230, which is closer to the free end. End region 230 isthus the location where the haptic/optic interface is most likely tofail. End region 230, with its larger surface area and tapering andbeveled configuration, acts to distribute the applying stresses (orstresses anytime haptic is reoriented relative to the optic) and preventthe haptic from disengaging from the optic.

The configuration of surface 220 can be modified in many ways to providethe desired joinery between the haptic and the optic. Joining the hapticand the optic in this manner (as opposed to having one component fitwithin the other) thus allows for many more interface configurations,which provides more flexibility in design.

In the embodiment of the haptic in FIG. 11, fluid aperture 240 iscentered along the midline of the haptic. The centerline is defined inthe same manner as described in FIG. 10. The centerline passes throughthe midpoint of the haptic height (measured in an anterior-to-posteriordirection) in a side view of the haptic.

Other aspects of the haptic can be the same as described herein, such asa thicker radially inner wall thickness along a portion of the haptic,and one or both haptics that follows the curvature of the periphery ofthe optic from the coupled end to the free end, and the anterior mostaspect of the haptic extending further anteriorly than the anterior-mostaspect of the optic.

The posterior element 140 has two fluid channels 210 therein that are influid communication with the haptic fluid chambers 170 and 190. Theouter edge of the posterior element 140 includes two apertures thereinthat define ends of the fluid channels 210. The haptic/optic interface(which can be a glue joint) surrounds the two fluid apertures in theposterior element 140. In some alternatives the optic only has one fluidchannel instead of two.

FIG. 13 is another view of haptic 160, showing the slight curvature ofoptic interface surface 220 and fluid aperture 240 therein.

FIG. 14 is a perspective view of the intraocular lens from FIG. 10,viewed from the posterior side. Fluid channels 210 can be seen in theposterior element 140, two of which are associated with each haptic. Theinterface between the haptics and optic can also be seen. FIG. 14 showssection A-A that is shown in FIG. 10.

FIG. 15 shows an additional view of the intraocular lens from FIG. 10,in which spacings 292 between the outer edge of optic and haptics can beseen, as well as the coupling between the optic and haptics.

In some embodiments in which one or more haptics are adhered to theoptic body at discrete locations, rather than 180 degrees around theoptic, a curing step that cures an adhesive that secures the haptic tothe optic body may cause shrinkage of the material at the location wherethe two components are adhered. This shrinkage at the discrete locationscan cause distortions in the lens, such as astigmatism. It can bebeneficial, or necessary, to prevent or reduce the extent of thedistortions. FIG. 16 illustrates an exploded perspective view ofalternative accommodating intraocular lens 300. FIG. 17 illustrates atop view of AIOL 300. FIG. 18 illustrates a perspective view of option301 of AIOL 300. FIG. 19 is a view of section A-A shown in FIGS. 17.

FIGS. 16-18 illustrate an exemplary interface between an exemplary opticbody 301 (see FIG. 18) and haptics 310 that may help alleviatedistortions due to shrinkage at the location where the optic body andhaptics are secured. The interface between the optic body 301 and thehaptics 310 is relocated radially away from the optic body 301, andspecifically the optical surfaces, compared to other embodiments such asin FIGS. 10-15. By moving the interface, and thus the location ofpotential shrinkage, away from the optical surfaces, the amount ofdistortion caused to the optical surfaces by the curing step can bereduced. A coupling region 311 of haptics 310 each interface with anoptic projection 303, such that the interface between the haptics andthe projection 303 is radially away from the optical surface of theoptic. This type of interface can be used with non-accommodating oraccommodating intraocular lenses, but in this embodiment the lens is anaccommodating intraocular lens.

For example, the accommodating intraocular lens 300 can comprise theoptic body 301 (see FIG. 18), and haptics 310. Is this embodiment,haptics 310 are manufactured separately from the optic 310, and thensecured to the optic 310. The haptics 310 each include a radially innerflat surface 312 (only one labeled in FIG. 16) that is secured to aradially peripheral surface 306 of the optic 310. In this embodimentsurface 312 is a radially inner surface of the coupling region 311 ofhaptic 310. For example, an adhesive can be used to secure surface 312to the radially peripheral surface 306 of the optic 310. The process ofsecuring the haptic to the optic may affect the optical performance ofthe optic 70, as discussed above. For example, the curing process of theadhesive may cause shrinkage of the optic 301 at two discrete locations,thus possibly resulting in distortion and aberration such as astigmatismof the intraocular lens.

In this embodiment, the intraocular lens comprises two projections 303extending radially outwards away from a peripheral surface 309 of theposterior element 304 of optic 301. The projections 303 can be thoughtof as projections from the general curved periphery of the optic, asdefined by outer edge surface 309. The haptics 310 can each have a firstportion 311 secured to the projection 303 and a free second portion 315disposed away from the first portion 311, wherein a radially innersurface of each of the haptics follows a radially outer peripheralsurface of the optic. Projection 303 may also be referred to herein as a“landing” or “land” in this disclosure.

Projections 303 can be raised areas extending between 10 microns and 1mm, optionally between 10 microns and 500 microns, radially outward fromthe periphery surface 309 of the optic. The radially peripheral surface306 of the projections 303 can be between 10 microns and 1 mm,optionally between 10 microns and 500 microns, farther away radiallyfrom a center of the optic than the peripheral surface 309 of the optic.For example, projections 303 can be a raised area extending between 100microns and 200 microns radially outward from the periphery surface 309of the optic. The radially outer peripheral surface 305 of projection303 may be between 100 microns and 200 microns farther away radiallyfrom a center of the optic than the peripheral surface 309 of the optic.Values outside the above range are also possible. Projections 303 canmove the securing surfaces or coupling surfaces away from the optic toprevent optic disruption due to shrinkage when curing the adhesivebetween the optic and the haptic.

In some embodiments the optic has a circular shape, in a top view, andthe radially outer peripheral edge 309 of the optic is generallycircular. When the projections are described herein as extendingradially away from the optic body, the projections may be extending awayfrom the general curve of the radially outer peripheral edge of theoptic.

In some embodiments, the optic and the projections 303 of theintraocular lens can be a single integral body. For example, projections303 can be molded as part of the optic. In some other embodiments,projections 303 can be attached to the optic, such as by gluing.

In some embodiments the optic 301 comprises a posterior element and ananterior element, optionally defining a fluid chamber therebetween, suchas in embodiments above. For example, projections 303 can be part of theposterior element because the posterior has a thicker periphery. Theprojections may also be part of the anterior element. For yet anotherexample, the projections can be part of the posterior element andanterior element of the optic.

Outer surfaces 306 of projections 303 and inner surfaces 312 of haptics310 can all be flat, such that they interface at a butt joint. Forexample, the radially outer peripheral surface 306 of projections 303can comprise a flat surface, optionally entirely flat. The radiallyinner surface 312 of haptics 310 can comprise a flat surface as well,optionally entirely flat. For another example, the radially outerperipheral surface 306 of projections 303 can comprise a curved surface,optionally entirely curved. The radially inner surface 312 of haptics310 can comprise a curved surface as well, optionally entirely curved. Acurvature of radially outer peripheral surface 306 can be the same asthe curvature of the periphery surface 309 of the optic body, and insome embodiments can be larger or smaller than the curvature of theperiphery surface 309 of the optic body.

Haptics 310 can comprise a peripheral fluid chamber as described herein.The projections 303 can comprise at least one fluid channel 308, andoptionally at least two channels, in fluid communication with theperipheral fluid chamber in the haptics. The raised projections 303 mayprovide more stability to the fluid channel because there is more opticmaterial at the locations of the projections.

In general, the projection can be disposed on a non-accommodating (fixedpower) intraocular lens that is manufactured by coupling haptics andoptic as well. For example, a fixed power intraocular lens, where theintraocular lens is a non-fluid filled optic body with a single power(e.g., PMMA material) and two haptics, can comprise a projectionextending radially outwards from a peripheral surface of the optic bodyas well.

The embodiment in FIGS. 16-19 also illustrate an alternative hapticcross sectional configuration (see FIG. 19 for the cross section) thatcan be incorporated into any of the suitable optics herein, such asoptic 100 shown in FIG. 10. The height H (measured in anterior toposterior direction) of haptics 310 can be from 2 mm-2.5 mm, and may be2.1 mm to 2.4 mm. This may be smaller than other haptic heights forother intraocular lenses, such as heights above 3 mm. It may beadvantageous, but not necessarily necessary, to have heights between 2and 2.5 mm for the haptics. There is some patient to patient variabilityin the size of the anatomy in the eye. There is variability in capsularsize, for example, or distance between capsule and the posterior side ofthe iris. With some haptics, there may be some rubbing between thehaptic and the posterior side of the iris. And even if there is, it maynot raise any concerns. It may thus be advantageous, merely in anabundance of caution, to have haptics heights that minimize the chanceof such rubbing.

Haptics 310 also include a radially inner wall portion 313 on theradially inner side of fluid chamber 316, which has a thickness “ti”that is greater than a thickness “to” of the haptic wall on the radiallyouter side of chamber 316. In some embodiments “ti” is between four andnine times greater than “to.” Radially inner wall portion 313 may bereferred to herein as a “spacer.” As shown in FIG. 16, the spacerextends along almost the entire length of haptic, but does not existwhere the spacing exists between the optic and haptic. The fluid chamber316 radially inner wall is, as shown, flatter than fluid chamber 316radially outer wall. Haptics 310 are examples of haptics that have across section, in a plane passing through an optical axis of the opticportion, in which the haptic fluid chamber is disposed in a radiallyouter portion of the haptic, and wherein a radially inner portion of thehaptic is non-fluid. Haptics 310 are examples of haptics that, in across section of a plane passing through an optical axis of the opticportion, and in a direction orthogonal to an optical axis of the opticportion through a midpoint of the haptic, have a radially inner fluidchamber wall thickness that is between four and 10 times the thicknessof a radially outer fluid chamber wall thickness. Haptics 310 areexamples of haptics that, in a cross section of a plane passing throughan optical axis of the optic portion, has an outer surface that is notsymmetrical about any axis passing through the peripheral portion andparallel to an optical axis of the optic portion, and wherein the haptichas, in a direction orthogonal to an optical axis of the optic portionthrough a midpoint of the haptic has a radially inner fluid chamber wallthickness greater than a radially outer fluid chamber wall thickness.Haptics 310 are examples of haptics that, in a cross section of a planepassing through an optical axis of the optic portion, having a heightdimension measured in an anterior to posterior direction, wherein thegreatest height of the peripheral portion in a radially outer half ofthe peripheral portion is greater than the greatest height of theperipheral portion in a radially inner half of the peripheral portion.

In some embodiments one or more aspects of the optic body have arefractive index that is between about 1.48 and 1.55, such as between1.50 and 1.53. In some embodiments the refractive index of one orcomponents is about 1.48, about 1.49, about 1.50, about 1.51, about1.52, about 1.53, about 1.54, or about 1.55. There may be a designedmismatch in refractive index between any of the anterior element, fluid,and posterior element, but in some embodiments there is a designed indexmatching between at least two of the components, and optionally allthree. When all components of the optic are designed to have the same orsubstantially the same index of refraction, they are said to beindex-matched. Any of the properties of the intraocular lenses (e.g.,refractive index, fluid, monomer compositions) described in U.S. Prov.App. No. 62/173,877, filed Jun. 10, 2015 can be implemented in any ofthe intraocular lens designs herein.

Exemplary materials that can be used to make any of the IOLs, includingfluid, herein, can be found in PCT/US2016/037055, fully incorporated byreference herein.

As described in some embodiments above, the accommodating intraocularlens can include first and second haptics that are adhered to the optic,and optionally about 180 degrees from one another around the optic.During lens formation, the haptics are adhered, or glued, to the optic,with an adhesive. The haptic/optic adhesion is important for a varietyof reasons. The haptics are deformed away from the optic, or splayed,during loading and delivery. It may be beneficial to have a relativelysofter adhesion joint between the optic and haptic to help with thedeformation of the haptic. If the haptic/optic joint is too rigid, itmay be difficult to deform the haptic or the haptic/optic joint duringloading and/or delivery. Secondly, the haptics are joined to the opticat two discrete locations around the optic. That is, the joint betweenthe haptic and optic does not extend all the way around the optic. Thiscreates an opportunity for the haptic/optic coupling to interfere withthe desired optical quality of the optic. For example, during curing ofan adhesive used to adhere the optic to the haptic, the adhesive canshrink and disrupt optical quality of the optic, such as by creating anastigmatism in the optic. To the contrary, it may not be as important touse a low modulus adhesive for adhering the anterior element and theposterior element in the optic, since that joint is annular, andshrinkage will not occur at discrete locations, like with thehaptic/optic coupling. In fact, it has been shown that optical qualityof the optic can be improved as a consequence of having a relativelyrigid adhesion ring joining the anterior and posterior elements of theoptic. For at least these two reasons, in some embodiments the adhesivefor the haptic/optic joint may be a relatively low modulus adhesive.

As set forth above, the adhesives used can include a CLP as a firstprimary component and a reactive acrylic monomer diluent (e.g., ADMA) asa second primary component, and can also include a third component. Ingeneral, as the CLP percentage goes up, the amount of shrinkage duringcuring goes down. It can thus be beneficial to increase the amount ofthe CLP in an adhesive when used for securing at least componentstogether in which it is desirable to reduce the amount of shrinkage thatoccurs, such as with a haptic/optic joint. In some of the embodimentsabove the second primary component (e.g., ADMA) is present in amount ofabout 18% to about 43%. While the adhesives in those examples could beused for the haptic/optic adhesive, some adhesive on the higher end ofthat range may be better suited for the optic joint between the anteriorand posterior elements, which there is less concern for the shrinkageoccurring all the way around the optic rather than at discretelocations.

In some embodiments, the adhesive for a haptic/optic coupling has agreater percentage of a CLP than the optic adhesive (between theanterior and posterior elements). Similarly, in some embodiments theadhesive for the haptic/optic coupling has less of a reactive acrylicmonomer diluent (e.g., ADMA) than the optic adhesive. In someembodiments the adhesive for the haptic/optic coupling has about 5-35%,such as 10-30%, or 15-25%, of the reactive acrylic monomer diluent(e.g., ADMA). The CLP can be about 50-85% of the adhesive. A thirdcomponent, such as laurel methacrylate, can also be included to increasestrength, flexibility, and provide low shrinkage. Laurel methacrylate isan example of a material with a low modulus, low shrinkage, and hassimilarly low diffusion characteristics as the reactive acrylic monomerdiluent (e.g., ADMA). This helps make the bonds between the haptic andoptic softer. In some embodiments securing the haptics to the opticcreates no more than a +/−0.3 D change in the optic duringmanufacturing.

Table 1 lists some exemplary adhesives that can be used, for example, asadhesives for the haptic/optic coupling. Each example also includes 2.3%of a photoinitiator, such as Darocur 4265. SR 313 is laurylmethacrylate, and provides water resistance, weatherability, impactstrength, flexibility, and low shrinkage, and other advantage describedherein. Exemplary shrinkages are provided for some examples.

TABLE 1 DMA @ DMA @ 35° C. 20° C. E′ at E′ at CLP- 0.1 1.0 0.1 1.0Viscosity 20 C. 35 C. Shrinkage Adhesive 1.5% F ADMA SR 313 Hz Hz Hz Hz40° C. (MPa) (MPa) % Gen 0-(65:35) 63.50 34.20 0.00 229 400 347  75028000 495.7 245.2 1.84 (1:0) SH11743-B- 68.39 29.31 0.00 n/a 140 n/a 380(70:30) (1:0) X8-(63.5:36.5) 63.51 22.80 11.40 37 75 61 200 (2:1)X5-(68.4:31.6) 68.39 22.00 7.31 52 90 85 220 (3:1) X4-(67.5:32.5) 67.5020.13 10.07 29 55 53 180 21233 120.8 45.7 1.52 (2:1) X7-(73.3:26.7)73.28 16.28 8.14 14 30 26 100 (2:1) X2-(67.5:32.5) 67.50 15.10 15.10 4 9 7 55 16471 16.6 3.1 (1:1) X6-(78.2:21.8) 78.16 13.03 6.51 5 15 10 55(2:1) X3-(67.5:32.5) 67.50 10.07 20.13 1 3 n/a 11 13011 4.0 45.7 (1:2)

In some alternative to the some embodiments above, the optic adhesiveincludes, in addition the CLP, HEA rather than HEMA.

The disclosure now includes a description of exemplary intraocularlenses that may help reduce posterior capsule opacification (“PCO”).Posterior capsule opacification (PCO) may be a major long-termcomplication of successful cataract surgery with some intraocular lens(TOL) implantation. The residual lens epithelial cells (LECs) canproliferate and migrate from the peripheral posterior capsular bag intothe space between the capsule and the optic of the intraocular ocularlens (TOL). This phenomenon can lead to PCO and decreased visual acuity.

Some accommodating intraocular lenses, for example, the accommodatingintraocular lenses described above, have been demonstrated to have theability to reduce or delay PCO. For example, haptics described above canfill the peripheral capsular bag and likely reduce LECs proliferation bytight contact with the capsule bag. However, this contact may not occurfor the entire 360° around the capsule, and there may be gaps betweenthe distal end tip of one haptic and the other haptic, or there may begaps between the optic and the interior of the haptic adjacent theoptic/haptic coupling location.

There may be, in some situations, advantages for peripheral portions ofintraocular lenses to be configured and adapted to further reduce thePCO effect to increase visual acuity.

FIG. 17 shows a top view of an exemplary intraocular lens, in which thespacing between the optic and haptics can be seen, as well as thecoupling between the optic and haptics.

As shown in FIG. 17, though the haptics 310 can substantially fill theperipheral capsular bag and likely reduce or prevent cellularproliferation by tight contact with the capsular bag, this contact isnot entire 360° around the capsule. There are small gaps between thedistal end tips 315 of the haptics and the proximal ends of the optichaptic. The residual LECs can proliferate and migrate from theperipheral capsular bag, such as from the equatorial region, into thespace between the capsule and the optic of IOL. LECs growth through thegap can be observed, which can lead to PCO and decreased visual acuity.In addition, LECs have been observed in the space between the optic andthe interior haptic adjacent to the location wherein the haptic couplesto the optic.

FIG. 20 is a top view illustrating an exemplary IOL comprising one ormore blunt tips 37 and 39 of the haptics. One or both of the tip of afirst haptic and the proximal end of the second haptic can be configuredto more closely fit together and reduce or eliminate the gap between thefree end tip 37of first haptic 36 and the proximal end of the secondhaptic 38, and the gap between the free end tip 39 of second haptic 38and the proximal end of the first haptic 36. The blunt 90° tips 37, 39can reduce the gaps and reduce PCO effect by preventing or reducing cellmigration and proliferation.

In some embodiments the distal tip of a first haptic can overlay, oroverlap (in a top view), the proximal portion of the second haptic toreduce or eliminate the gap. For example, the distal tip of a firsthaptic can be tapered to overlay the second haptic. The free end of thesecond haptic can also be overlay (e.g., tapered) to overlay the firsthaptic to reduce or eliminate the gap. The proximal ends of both ofthese exemplary haptics are tapered towards the coupling location withthe optic, so the distal ends of the adjacent haptic can similarly betapered (such as with a complimentary taper) to form the overlappingregions of first and second haptics. Since the IOL is dialed clockwise,the proximal end can be configured to have a taper while the distal tipcan be configured with a variety of shapes. In some other embodimentsthe distal tips can further comprise a radial barrier to preventcircular migration of LECs which can contribute to LECs growth in thegap.

FIG. 21 illustrate a section view of an exemplary IOL with one or morecircumferential ridges (e.g., 46 a, 46 b, 48 a, and 48 b) on the haptics46 and 48. Only a section of the ridges are shown, but the ridges extendalong at least a portion of the length of the haptics. The haptic/bagcontact can be improved with the one or more circumferential ridges(e.g., 46 a, 46 b, 48 a, and 48 b) having sharp edges (i.e., notsmooth). For example, the one or more ridges 46 a, 46 b with sharp edgescan extend along at least a portion of the length of and on an outersurface of the haptics 46. The ridge 46 a can be disposed on a topsurface of the haptic 46 while the ridge 46 b can be disposed on abottom surface of the haptic 46 Similarly, the one or more ridges 48 a,48 b with sharp edges can extend along at least a portion of the lengthof and on an outer surface of the haptics 48. The ridge 48 a can bedisposed on a top surface of the haptic 48 while the ridge 48 b can bedisposed on a bottom surface of the haptic 48. In this exemplaryembodiment, the “top” is considered the anterior portion and the“bottom” is the posterior portion. Axis (or plane) B-B is considered todivide the IOL between anterior and posterior sides, and axis or plane Bcan be considered to pass through the “equator” of the haptics (whichare generally aligned with the equator of the capsular bag). Forexample, ridges 48 a and 46 a are disposed on the anterior side of thehaptics, and ridges 46 b and 48 b are disposed on the posterior side ofthe haptics.

The ridges (e.g., 46 a, 46 b, 48 a, and 48 b) on the haptics 46, 48 canhave cross sections with sharp edges, such as square edges. It has beenfound that square-edged optics can reduce the incidence of PCO effectfollowing cataract surgery. It has been shown in earlier attempts,dating back to the early 1990s, that square-edged optics have reducedPCO development. Discontinuous capsular bend may be an important factorfor the PCO prevention effect. In general, the proliferating LECs startfrom the equator and divide and migrate toward the center. The ridges(e.g., 46 a, 46 b, 48 a, and 48 b) on the haptics 46 or 48 can createbarriers to LECs movement by creating capsular bends, thus creating asquare edge effect. Therefore, LECs migration can be significantlyreduced or eliminated by one or more of the ridges.

FIG. 22 is a bottom (posterior) view of an exemplary IOL, illustratingridges 46 b and 48 b of the two haptics (from FIG. 21), both ridgeslabeled “R” in FIG. 22. In FIG. 22, the ridges extend along the entirelength of both haptics, but in some embodiments they do not extend alongthe entire length. For example, in some embodiments the ridges mayextend along at least 75%, 80%, 85%, 90%, or 95% of the length of thehaptic. The length of the haptic is measured along an equator of thehaptic, from the coupling location with the optic, to the distal freeend. The length of the haptic is thus generally measured along a curvedline. The length of the haptic, may be, in some cases, considered astraight line measured as the shortest distance from the optic couplinglocation to the distal free end.

The ridges (e.g., 46 a, 46 b, 48 a, and 48 b) can extend along at leasta portion of the length of the peripheral portion of the IOL. Theperipheral portion can include one or more haptics, for example, 46 and48, but the IOL may include more or less that two haptics. For example,the IOL may have a single annular peripheral portion with one or moreridges. The IOL could also have, for example, four haptics each its owncoupling to the optic, wherein one or more of the four haptics includesone or more ridges

The ridges (e.g., 46 a, 46 b, 48 a, and 48 b) can create “square edgeeffect” although the ridges may not need to be square. A triangularridge may suffice. However, other shapes with at least one sharp edgecan work as well. The phrase “sharp edge” as used herein refers to anedge that is not a rounded edge. In some embodiments the ridges can haveat least one 90 degrees edge, in a cross section. In some embodimentsthe ridges can have at least one edge less than 100 degrees, in a crosssection. In some embodiments the ridges can have at least one edge lessthan 120 degrees, in a cross section. In some other embodiments theridge does not have a 90 degree edge in a cross section, for example,the ridge can have a 60 degrees triangle edge. In some embodiments atleast two ridges (e.g., 46 a and 46 b) have the same configuration. Insome other embodiments a first ridge has a different configuration thana second ridge (not shown). One or all of the ridges can have the sameconfiguration, or some may have one configuration while others have adifferent configuration. For example, ridges on one side (e.g.,anterior) may have a triangular configuration while ridges on the otherside (e.g., posterior) may have a square configuration.

The height of the ridges (measured in the anterior-to-posteriordirection) can be about 50 μm to about 500 μm in some embodiments, suchas about 100 μm to about 300 μm. When the ridges have a square edgecross section, the width (measured radially) can be can be about 50 toabout 500 μm in some embodiments, such as about 100 μm to about 300 μm.The ridges can be configured to be wide enough to prevent the ridge fromfolding over when implanting. The square edge cross section is definedherein as a cross section includes at least one edge less than 100degrees. When the ridges have a triangle cross section, the base of theridge can be similar in size, for example, about 50 μm to about 500 μmin some embodiments, such as about 100 μm to about 300 μm. The ridges donot need to be the same size (for example, one or more ridges can havedifferent height and width values). Values outside the above ranges arealso possible.

The haptic (e.g., 46, 48) can comprise a ridge (e.g., 46 b, 48 b)disposed on a posterior side (a bottom surface) in some embodiments. Thehaptic (e.g., 46, 48) can comprise a ridge (e.g., 46 a, 48 a) disposedon an anterior side (a top surface) in some other embodiments. In someembodiments the haptic (e.g., 46, 48) can comprise one or more ridges(e.g., 46 a, 48 a) disposed on an anterior side and one or more ridges(e.g., 46 b, 48 b) disposed on a posterior side to block LECs from bothsides. The second ridge can further reduce the PCO effect, but in someinstances the second ridge may not be required. One or both haptics canhave more than one ridge on an anterior side, or more than one ridge ona posterior side. For example, haptic 48 can include two ridges 48 bspaced apart from one another on haptic, but both being disposed on theposterior side of haptic.

In some additional embodiments the haptic (e.g., 46, 48) can compriseone ridge (not shown) disposed on the equator of the peripheral portion.For example, in FIG. 8, one or both haptics can include a ridgesymmetric about axis or plane B-B, extending radially outward to theleft or right in the figure. However, ridges on the equator of thehaptic can be optional. The numbers of the ridges on a haptic can be,for example, 1, 2, 3, 4, 6, 8, 12, 20 or any numbers therebetween or anyother numbers. For example, two ridges can be disposed circumferentiallyon an anterior portion (top) and on a posterior portion (bottom), 180°apart and optionally with one or more additional ridges between theanterior portion (top) and the posterior portion (bottom). In FIG. 21,ridge 48 a and 48 b are 180 degrees part, but they need not be. Forexample, ridge 48 a could be moved 45 degrees toward the equator ofhaptic 48 while ridge 48 b could be in the same position as shown. Theridges can be, but do not need to be symmetrically placed around thehaptic.

The ridges described herein can be thought of generally as extensionsthat extend away from the natural curvature of the haptic. For example,when a square edge is used, the transition between the haptic curvatureand the ridge can be a region where the haptic has a sharp bend, ortight curve, as the ridge extends away from the surface of the haptic.The ridge can be described in this manner at both transition regionswith the general curvature of the haptic.

The ridges can be formed in a number of ways. The haptic can be moldedwith the one or more ridges formed therein (considered integral with thehaptic material). Alternatively, separate sections of material can beadhered to the outer surface of the haptic after the haptic is molded(considered non-integral with the haptic material). Any of the ridgescan be the same or different material as the haptic material. Forexample, one or more ridges can be a material that is stiffer than thehaptic material that can be adhered (e.g., glued) or co-molded onto thehaptic.

For some intraocular lenses, scattering from the periphery of the opticportion of the intraocular lenses can reduce the optical quality of theintraocular lens. It may be beneficial, but not necessary, for theintraocular lens to be further adapted and configured to reduceperipheral scattering. FIG. 23A illustrates a top view of an exemplaryIOL comprising an opaque periphery. FIG. 23B illustrates a perspectivesection view of the IOL comprising an opaque periphery from FIG. 23A.Referring to FIGS. 23A-B, an intraocular lens (IOL), for example, anaccommodating intraocular lens, can comprise an optic portion 510, anopaque periphery 510 b around the optic portion 510, and a peripheralportion optionally including at least two haptics 516 and 518 coupled tothe optic portion 510. The opaque periphery 510 b can be adapted toabsorb the scattered light, thus limit light scattering.

In some embodiments the opaque periphery 510 b comprises a layer ofopaque material, optionally a polymer, disposed on a peripheral edge ofthe optic portion. A layer of opaque polymer may need to meet therequirements for implantable materials. A layer of opaque polymer mayalso need to be bio-compatible and have stable properties. In someembodiments an opaque polymer can co-molded with the optic portion 10during the IOL manufacturing process. In some embodiments an opaquepolymer can be deposited on a peripheral edge of the optic portion 10after the IOL has already been manufactured.

In some embodiments the opaque periphery 510 b can comprise a layer ofblack glue disposed on a peripheral edge of the optic, which could alsobe used as a glue to adhere the optic and haptics.

In some embodiments the opaque periphery 510 b comprises a layer ofblack paint disposed on the optic edge.

In some embodiments the opaque periphery 510 b comprises a cylindricalstructure, such as a black cylindrical structure, attached to an edge ofthe optic portion 510. This approach can reduce the complexity in theIOL manufacturing. A variety of methods can be used to attach acylindrical structure to the IOL.

FIGS. 24-26C, which will now be described, are related to the fulldisclosure in WO2014/145562A1, which is incorporated by referenceherein. A variety of intraocular lens (“IOL”) loading and deliverydevices, systems, and methods of use have been described in recentyears. However, the issues related to residual air have not beenadequately addressed yet. For example, residual air around the IOL andin the fluid chambers of the injector system can lead to issues duringIOL delivery. For example, air in a viscoelastic stream before andaround the IOL during delivery can obscure the visualization of the IOLand eye during delivery and after delivery during the manipulation andfinal placement of the IOL in the eye, such as in the capsule.Additionally, compressed residual air behind the IOL during the highestpressure of the IOL body delivery can lead to uncontrolled delivery ofthe IOL into the eye. This can occur as the IOL body passes the mostconstricted portion of the delivery device, and allows the compressedair proximal of the IOL to expand and push the IOL forward without userinput. While this could theoretically be used as an advantage in sometypes of delivery, uncontrolled IOL delivery is generally undesirable.

Loading and delivery devices, systems, and method of use are needed thatcan effectively perform air management, including residual air removalin loading and pre-delivery.

FIG. 24 is a section view of a cartridge 660 with an IOL 640 loadedinside by a push member 630 according to one embodiment of thedisclosure. The IOL 640 can be any of the IOLs described above, or mayin some embodiments be an IOL not described herein. For example, the IOL640 can be the same or similar to the IOL 340 in FIG. 22 inWO2014/145562A1. The IOL 640 can comprise optic portion 643, leadinghaptic 641 and trailing haptic 642 as shown in FIG. 24. Leading haptic641 is disposed distally to optic 643, and trailing haptic 642 isgenerally proximal to optic 643. The cartridge 660 can be any type ofcartridge, such as those described herein or even other cartridges notdescribed herein. For example, the cartridge 660 can be the same as orsimilar to the exemplary cartridge 360 in FIG. 18. The carrier 600 canbe any type of carrier, shown herein or not. For example, the carrier600 can be the same as or similar to the cartridge 400 in FIGS. 16, 17and 18 in WO2014/145562A1. The cartridge 660 can be secured to thedistal cartridge receiving area of carrier 600.

Prior to use, the loading carrier 600 can be sterilized and shipped withthe IOL 640 disposed therein. Optionally, the cartridge 660 can beattached before sterilization, or the cartridge 660 can be attached atthe time of loading. A viscoelastic material 680 can be introduced tothe carrier 600 through a port in the side of the loading carrier 600that has a communicating port adjacent to the IOL 640. For example, theviscoelastic port (not shown) can be the same as or similar to the sideport 319 in FIGS. 16 and 17 in WO2014/145562A1. The viscoelastic portcan be designed to mate with standard syringes, and has a pathway thatleads to the proximity of the IOL 640. The port conveys viscoelasticfrom a syringe or other viscoelastic delivery aid to the area around theIOL 640 prior to the splaying and loading steps.

The push member 630 can be any type of push member or loading member,shown herein or otherwise. The push member or loading member 630 canmove distally to engage with and advance the IOL 640 into the cartridge660 (or other delivery device or delivery lumen) and placing it at apredefined position in the cartridge 660 to be ready for furtherassembly of a delivery device, such as a plunger. In some embodiments,the push member 630 can be the same as or similar to the push member 330in FIGS. 17 and 20 in WO2014/145562A1. The push member or loading member630 can comprise an elongate body, a first extension extending distallyand in an upward direction relative to a top portion of elongate body ata hinge and a second extension extending distally and in a generallylinear orientation with respect to the proximal portions of load body,similar to the loading member in FIG. 20 in WO2014/145562A1. In someother embodiments, the push member 630 can be the same as or similar tothe push member 40 in FIG. 14 in WO2014/145562A1.

The carrier 600 can comprise a carrier cover, or lid 650, and can be anyof the lids herein. Lid 650 can cover the portion of base 610 where theIOL 640 is positioned.

As shown in FIG. 24, loading the IOL 640 from the loading carrier 600and into the cartridge can result in the IOL 640 being disposed in thecartridge 660, surrounded by the viscoelastic material 680, but withlocalized air bubbles over the anterior portion of the IOL 640 and nearthe proximal haptic 642. If this air is not removed, it can move forwardof the IOL 640 during delivery and obscure visibility during thesurgery, as mentioned above.

The disclosure includes exemplary methods of air management in an IOLloading and delivery system. The methods will be described generallywithout reference to specific parts of the devices herein, althoughexamples will be given in the context of certain embodiments. Not allsteps need necessarily be performed, and the order may vary.

FIGS. 25A-C illustrate a method of removing air (or “de-bubbling”) fromaround the IOL 640 during loading, and before connecting a deliverydevice to the cartridge 660. In general, the air over the anteriorportion of the IOL 640 and near the proximal haptic 642 can be removedor displaced away from the IOL 640 before mounting the delivery device,for example, a plunger assembly, to the cartridge 660.

In some embodiments, the method can comprise removing the cartridge fromthe carrier, and passing a syringe with cannula over the top of the IOL,wherein the syringe can be filled with a viscoelastic material. Theviscoelastic material can be used to displace the air towards theproximal side of the IOL. The syringe can pass the top of the IOL fromthe distal end in some embodiments. In some other embodiments, thesyringe can pass the top of the IOL from the proximal end. The cannulamay be in close proximity to the optic 643 of the IOL 640. Care needs tobe taken to avoid damage to the optic 643 of the IOL 640.

In some embodiments, the air over the anterior portion of the IOL 640and near the proximal haptic 642 can be removed when the loading memberor push member 630 is retracted, as shown in FIGS. 25A-C. The carrierlid 650 can comprise an opening 655 to insert the syringe 658 with thecannula as shown in FIG. 25A. The cannula of the syringe 658 can beinserted through the opening 655 while the push member 630 is stilladvanced at the last step of the loading and over the anterior portionof the IOL 640. The cannula can be advanced to a position over theanterior portion of the IOL 640. The syringe 658 can insert aviscoelastic material 682 to displace the air over the anterior portionof the IOL 640, or air at any other location within the cartridge. Theviscoelastic material 682 can be the same or different than theviscoelastic material 680 inserted from the side port of the carrier600. In some other embodiments, the base of the carrier 600 can comprisean opening to insert a syringe with a cannula to displace the airadjacent the IOL. In some alternative embodiments, the side of thecarrier 600 can comprise an opening to insert a syringe with a cannulato displace the air over the anterior portion of the IOL or other areasadjacent the IOL.

The method of removing air from the IOL 640 during loading can compriseplacing a cannula of a viscoelastic syringe over the anterior portion ofthe IOL 640 while the push member 630 is still advanced at the last stepof the loading, and inserting a viscoelastic material over the anteriorportion of the IOL 640 while the push member 630 is retracting.

FIG. 25B illustrates a section view when the push member is beingretracted. The volume around the push member can be filled with theviscoelastic material 682 so that after the push member is retracted,the volume that is displaced is replaced with the viscoelastic material682 instead of air. After the push member is completely retracted, theproximal channel can be left full of the viscoelastic material 682. Thismethod has the advantages of reducing the need for a cannula to be inclose proximity to the IOL optic 643. In some embodiments, the methodcan further comprise making a mark on the loading carrier 600 to wherethe viscoelastic material 682 needs to be filled to be effective in apredetermined volume.

FIGS. 25A-C illustrate a method of air venting of IOL during thedelivery process. The cartridge 660 with the IOL 640 loaded inside canbe connected to a delivery system, which can deliver the IOL 640 into aneye of a patient. For example, the delivery system of the IOL 640 can bethe delivery system described in U.S. Pat. No. 8,968,396, titled:“Intraocular Lens Delivery Systems and Methods of Use”, filed Mar. 15,2013, which is herein incorporated by reference in its entirety. Thedelivery system can comprise a plunger assembly 690 as shown in FIG.25A. The plunger assembly 690 can include a lumen extending from aproximal end to a distal end. This allows the viscoelastic fluid, orother material, to be delivered from the proximal end of the plunger 690into the cartridge 660, pushing the loaded IOL 640 from within thecartridge 660 out the distal tip (shown with a bevel) and into thepatient's eye. Plunger 690 has a proximal portion that is adapted tointeract with a fluid delivery device, such as a syringe, so that fluidcan be advanced from the fluid delivery device and into the inner lumenwithin plunger 690. Distal end of plunger 690 is disposed within thecartridge 660, and thus the fluid is delivered to a location that isradially and axially within the lumen, even if it does not exit theplunger 690.

When the IOL 640 is loaded into the cartridge 660 from the carrier, thecartridge 660 is removed from the carrier and the plunger assembly 690can be mounted to the cartridge 660 proximal to the IOL 640. The IOL 640in the cartridge 660 at this point is encapsulated in the viscoelasticmaterial. At this point the plunger 690 is not full of a viscoelasticmaterial but only air in the open fluid pathways. There is a void ofviscoelastic proximal to the IOL 640.

After the IOL 640 is loaded into the cartridge 660 as shown in FIG. 26A,a viscoelastic fluid, or other type of fluid, can delivered from asyringe and into lumen of plunger 690 (see FIG. 26B). The viscoelasticfluid can delivered from the distal port of plunger 690 and into contactwith the IOL 640, forcing the IOL 640 distally within cartridge 660 andout the distal end of the cartridge 660. In general, the delivery of theIOL 640 from the cartridge 660 relies on development of pressuredifferential in the viscoelastic over the IOL 640 to move it down thereducing section of the cartridge 660 and into the eye.

The compressed residual air behind the IOL 640 during the highestpressure of the IOL 640 delivery can lead to uncontrolled delivery ofthe IOL 640 into the eye as the IOL body passes the most constrictedportion of the cartridge 660. The compressed air proximal of the IOL 640can be expanded and push the IOL forward without user input, which canpossibly damage the IOL 640 or the capsule in the eye, or even cause theIOL 640 to be delivered outside of the capsule. The purging of air isimportant for a smooth, controlled delivery of the IOL 640.

When the cartridge tip is placed in the eye and the screw drive isbeginning to be advanced, the viscoelastic fluid of the plunger 690displaces air forward out of the plunger 690 by filling the luerfitting, support tube, through the semi porous expanded PTFE tubing andthen being redirected back around the support tube and down through theexhaust vent 695. The forward direction is towards the tip of thecarrier 660. The air is followed by the viscoelastic fluid to the vent695 due to this being the lowest pressure path since the IOL 640 isfully or partially sealing against the cartridge 660 wall. The forwardpath to the tip is blocked by the IOL 640 and loading viscoelasticmaterial. When the vent 695 seals with viscoelastic fluid, the system isable to develop pressure to move the IOL 640 forward to the tip of thecartridge 660 without a significant amount of air behind the IOL 640 asshown in FIG. 26C.

As shown in FIGS. 26A-C, the viscoelastic fluid travels from a syringethrough support tube and exits in proximity of the trailing haptic ofthe IOL 640 within a plug element, for example, an EPTFE membrane. Thefluid front travels both distally filling the plug element, and rearwardevacuating the volume air through vent 695. The vent 695 will not passviscoelastic so is able to maintain pressure when fully evacuated. Thiseffect purges the air from the back of the system to reduce springeffects of trapped air during the release of the IOL 640 duringdelivery.

In some embodiments the delivery system includes a vent and does notinclude a plug, or sealing element. In these embodiments fluid such asviscoelastic is delivered towards the IOL 640 as part of the deliveryprocess. Air venting to increase control during delivery whiledecreasing the volume of air bubbles that are moved forward through thetip into the eye provides a significant advantage even in the absence ofa plug element.

The following disclosure of FIGS. 27-28D is related to the fulldisclosure of WO2013/142323, which is fully incorporated by referenceherein. Intraocular lenses are positioned within a patient's eye, suchas in the anterior chamber or posterior chamber. After making a smallincision in the eye, a physician typically positions a distal opening ofa delivery device within or adjacent to the opening. The physician thendelivers the intraocular lens out of the delivery device, through theopening, and into the target location within the eye. In someprocedures, but not all, an intraocular lens is delivered into a nativecapsule after the native lens has been removed.

Some intraocular lenses, because of their size and/or theirconfiguration, and possibly the desired incision size, need to bereconfigured and/or have at least a first portion reoriented withrespect to a second portion to be delivered into an eye. When someintraocular lenses are advanced through a delivery device and/ordelivered out of the delivery device, forces on the intraocular lens candamage the intraocular lens.

What are needed are delivery systems and methods of use that can deliveran intraocular lens without damaging the intraocular lens.

FIG. 27 is a top view of an exemplary cartridge 401, which can be usedto deliver an intraocular lens into an eye. Cartridge 401 is an exampleof any of the cartridges described herein. The cartridge 401 cancomprise a proximal opening 405 disposed to be engaged with a loadingcarrier to accept the intraocular lens (not shown), and a distal tip 411adapted to deliver the intraocular lens into an eye. The cartridge 401can comprise a lumen 410 extending from the proximal opening 405 to thedistal tip 411. The lumen 410 can comprise a cross section having afirst axis X and a second axis Y of an internal ellipse. The lumen 410can further comprise a first portion 491 adapted to engage with theloading carrier and, without limitation, begin to fold the intraocularlens without stretching the intraocular lens out, a second portion 492adapted to, without limitation, form a seal (or at least substantialseal) between an inner wall and the intraocular lens, and a thirdportion 493 adapted to, without limitation, compress the intraocularlens to extend the intraocular lens in length.

The intraocular lens can be disposed within lumen 410 and positioned tobe deployed out of the distal tip 411 of the cartridge 401. The distalend of a plunger, such as any of the plungers herein, can be disposedwithin the proximal opening 405 in the cartridge 401 when assembled. Thecartridge 401 can be adapted to accept the intraocular lens from theloading carrier into the cartridge 401, and have a tapered distal end todeform, compress, and optionally stretch out the intraocular lens in todeliver the intraocular lens into the eye.

FIGS. 28A-C illustrate exemplary internal cross sections DD, CC, BB andAA of the cartridge 401 in FIG. 27. Section DD represents the proximalopening 405. Section CC represents the intersection of the first portion491 and the second portion 492. Section BB represents the intersectionof the second portion 492 and the third portion 493. Section AArepresents the distal end of the third portion 493, and shows the crosssection of the distal-most region of cartridge 401. Referring to FIGS.27 and FIGS. 28A-C, as the intraocular lens is pushed through thecartridge 401 (right to left as shown in FIG. 27), the cartridge 401internal cross-section transitions from a lumen 410 large enough to holdthe lens without compressing it (assuming the haptics are splayed outaway from the lens body) at section DD all the way down to the final,compressing lumen 410 shown in section AA.

In some embodiments the transition from section DD to CC is that both afirst radius 410 a along the first axis X and a second radius 410 balong the second axis Y on the cross section shrinks from the proximalopening 405 to section CC, which serves to interface with the lenscarrier, accept the lens into the cartridge 401, and fold the lens bodywithout stretching it out. In some embodiments, both the first radius410 a and the second radius 410 b on the cross section decrease from theproximal opening 405 to the section CC. In some embodiments, the firstradius 410 a on the cross section at the proximal opening 405 is fromabout 2 mm to about 7 mm. For example, the first radius 410 a on thecross section at the proximal opening 405 can be from about 4.6 mm toabout 5.6 mm. Values outside the above range are also possible. In someembodiments a second radius 410 b on the cross section at the proximalopening 405 is from about 1 mm to about 6 mm. For example, the secondradius 410 b on the cross section at the proximal opening 405 can befrom about 3.5 mm to about 4.5 mm. Values outside the above range arealso possible.

In some embodiments the first radius 410 a is larger than the secondradius 410 b on the cross section from the proximal opening 405 to theintersection of the first portion and the second portion CC. In someembodiments the first radius 410 a on the cross section at anintersection CC of the first portion 491 and the second portion 492 isfrom about 1.5 mm to about 6.5 mm. For example, the first radius 410 aon the cross section at section CC can be from about 4.0 mm to about 5.0mm. Values outside the above range are also possible. In someembodiments the second radius 410 b on the cross section at theintersection CC is from about 0.5 mm to about 5.5 mm. For example, thesecond radius 410 b on the cross section at section CC can be from about2.6 mm to about 3.6 mm. Values outside the above range are alsopossible.

Between sections CC and BB the lens is forming a substantial sealagainst the inner wall of the lumen 410. In some embodiments the firstradius 410 a and the second radius 410 b on the cross section decreasefrom the intersection CC of the first portion 491 and the second portion492 to the intersection BB of the second portion 492 and the thirdportion 493.

In some other embodiments the first radius 410 a decrease but the secondradius 410 b remains the same on the cross section from the intersectionCC to the intersection BB. In some embodiments the first radius 410 a islarger than the second radius 410 b on the cross section at theintersection CC, and the first radius 410 a is smaller than the secondradius 410 b on the cross section at the intersection BB. In someembodiments the first radius 410 a on the cross section at theintersection BB of the second portion 492 and the third portion 493 isfrom about 0.5 mm to about 5 mm. For example, the first radius 410 a onthe cross section at intersection BB can be about 2.6 mm to about 3.6mm. In some embodiments the second radius 410 b on the cross section atthe intersection BB is from about 0.5 mm to about 5.5 mm. For example,the second radius 410 b on the cross section at intersection BB can beabout 2.2 mm to about 3.2 mm. Values outside the above range are alsopossible.

Between sections BB and AA the lens is being stretched out by the rapidreduction of cross sectional area (to below the minimum cross sectionalarea of the lens itself). This causes the lens to extend in length. Insome embodiments both the first radius 410 a and the second radius 410 bon the cross section decrease from the intersection BB of the secondportion 492 and the third portion 493 to a distal end AA of the thirdportion 493. In some embodiments the first radius 410 a is differentthan the second radius 410 b on the cross section at the intersectionBB, and the first radius 410 a is the same as the second radius 410 b onthe cross section at the distal end AA. In some embodiments the crosssection changes from an elliptical shape to a circular shape in thethird portion.

In some embodiments the first radius 410 a and the second radius 410 bon the cross section decrease at a first average rate from the proximalopening 405 to the intersection CC, the first radius 410 a and thesecond radius 410 b on the cross section decrease at a second averagerate from the intersection BB to the distal end AA, and the secondaverage rate is larger than the first average rate. In some embodimentsthe first radius 410 a is the same as the second radius 410 b on thecross section at the distal end AA. In some embodiments a radius of across section at a distal end AA of the third portion is from about 0.1mm to about 4 mm. For example, the radius 410 c on the cross section atintersection AA can be about 1.5 mm to about 2.5 mm. Values outside theabove range are also possible.

From section AA to the tip there is no change in cross-sectional area.In some embodiments, the apparatus can further comprise a fourth portionextending from the distal end AA of the third portion 493 to the distaltip 411. In some embodiments the cross section remains the same from thedistal end AA of the third portion 493 to the distal tip 411.

One aspect of the disclosure is a method of delivering an intraocularlens into an eye. The method can comprise engaging a delivery device toa loading carrier to accept the intraocular lens. The method cancomprise folding the intraocular lens without stretching the intraocularlens out. The method can comprise forming a seal between an inner wallof the delivery device and the intraocular lens. The method can comprisecompressing the intraocular lens to extend the intraocular lens inlength and delivering the intraocular lens into the eye.

In some embodiments the step of folding the intraocular lens comprisesdecreasing a first radius along a first axis and a second radius along asecond axis of an internal ellipse of a cross section of the deliverydevice at a first average rate. In some embodiments compressing theintraocular lens comprises decreasing a first radius along a first axisand a second radius along a second axis of an internal ellipse of across section of the delivery device at a second average rate. In someembodiments the second average rate during the step of compressing theintraocular lens is larger than the first average rate during the stepof folding.

Characteristics of the intraocular lenses described herein can similarlybe applied to non-fluid driven accommodating intraocular lenses. Forexample, a non-accommodating intraocular lens can include a peripheralportion with a first stiffer region that provides a region of theperipheral portion with an insensitivity in a first direction. Forexample, in an intraocular lens with two lenses adapted to be movedapart from one another to change the power of the lens, the peripheralportion of the lens can be adapted such that a first type of capsularreshaping does not cause the distance between the lenses to change, andthus the power of the intraocular lens stays the same.

Additionally, the accommodating intraocular lenses herein can also beadapted to be positioned outside of a native capsular bag. For example,the accommodating intraocular lenses can be adapted to be positioned infront of, or anterior to, the capsular bag after the native lens hasbeen removed or while the native lens is still in the capsular bag,wherein the peripheral portion of the lens is adapted to responddirectly with ciliary muscle rather than rely on capsular reshaping.

We claim:
 1. An intraocular lens, comprising: an optic portion; and ahaptic comprising one or more ridges extending along at least part of alength of the haptic, wherein each of the ridges comprises edges thatmeet at a corner.
 2. The intraocular lens of claim 1, wherein the corneris defined by an angle of 90 degrees.
 3. The intraocular lens of claim1, wherein the corner is defined by an angle of 60 degrees.
 4. Theintraocular lens of claim 1, wherein the corner is defined by an angleof 120 degrees.
 5. The intraocular lens of claim 1, wherein at least oneof the ridges extend from a top or an anterior outer surface of thehaptic.
 6. The intraocular lens of claim 1, wherein at least one of theridges extend from a bottom or a posterior outer surface of the haptic.7. The intraocular lens of claim 1, wherein at least one of the ridgesextend from an equator of the haptic.
 8. The intraocular lens of claim1, wherein at least one of the ridges extend along an entire length ofthe haptic.
 9. The intraocular lens of claim 1, wherein at least one ofthe ridges extend along at least one of 75%, 80%, 85%, 90%, and 95% ofthe length of the haptic.
 10. The intraocular lens of claim 1, whereinat least one of the ridges has a ridge height of between 50 μm to 500μm.
 11. The intraocular lens of claim 1, wherein at least one of theridges is a square-shaped ridge.
 12. The intraocular lens of claim 11,wherein the square-shaped ridge has a ridge width of between 50 μm to500 μm.
 13. The intraocular lens of claim 1, wherein at least one of theridges is a triangular-shaped ridge.
 14. The intraocular lens of claim13, wherein the triangular-shaped ridge has a base width of between 50μm to 500 μm.
 15. The intraocular lens of claim 1, wherein the opticportion comprises an optic fluid chamber, wherein the haptic comprises ahaptic fluid chamber, wherein the haptic fluid chamber is in fluidcommunication with the optic fluid chamber.
 16. An intraocular lens,comprising: an optic portion comprising an anterior element and aposterior element with an optic fluid chamber defined therebetween,wherein the optic portion comprises an opaque periphery; and a hapticcomprising a haptic fluid chamber, wherein the haptic fluid chamber isin fluid communication with the optic fluid chamber.
 17. The intraocularlens of claim 16, wherein the opaque periphery comprises a layer ofopaque material.
 18. The intraocular lens of claim 17, wherein theopaque material is an opaque polymer.
 19. The intraocular lens of claim18, wherein the opaque polymer is co-molded with the optic portion. 20.The intraocular lens of claim 18, wherein the opaque polymer isdeposited along a peripheral lateral surface of the optic portion afterthe intraocular lens has been manufactured.
 21. The intraocular lens ofclaim 16, wherein the opaque periphery is made of a black-coloredadhesive disposed along a peripheral lateral surface of the opticportion.
 22. The intraocular lens of claim 16, wherein the opaqueperiphery comprises black paint covering a peripheral lateral surface ofthe optic portion.
 23. The intraocular lens of claim 16, wherein theopaque periphery is cylindrical in shape.
 24. The intraocular lens ofclaim 23, wherein the opaque periphery is a black cylindrical structuresurrounding a peripheral lateral surface of the optic portion.
 25. Theintraocular lens of claim 16, wherein the opaque periphery is configuredto absorb scattered light.